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Localization of islet cell tumors
J L Doppman1, T H Shawker, D L Miller
1Diagnostic Radiology Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland.
Gastroenterology Clinics of North America
|December 1, 1989
Summary
Localization and surgical success for insulinomas (insulin-secreting tumors) exceed 90%, aided by specialized imaging. Gastrinomas (Zollinger-Ellison syndrome) present greater localization challenges, but prognosis is good with controlled acid hypersecretion.
Area of Science:
- Endocrinology
- Surgical Oncology
- Diagnostic Imaging
Background:
- Islet cell tumors, including insulinomas and gastrinomas, require accurate localization for effective treatment.
- Surgical success rates vary significantly between these tumor types despite similar imaging modalities.
Purpose of the Study:
- To compare the diagnostic and surgical success rates of imaging techniques for insulinomas versus gastrinomas.
- To outline optimal management strategies based on tumor type and localization challenges.
Main Methods:
- Review of imaging techniques including portal venous sampling, intraoperative ultrasound, computed tomography (CT), and angiography.
- Analysis of surgical outcomes and long-term follow-up for patients with insulinomas and gastrinomas.
Main Results:
- Insulinomas demonstrate over 90% successful resection rates, critically dependent on portal venous sampling and intraoperative ultrasound.
- Gastrinomas, particularly sporadic Zollinger-Ellison syndrome, have detection rates below 80% due to small size and extrapancreatic locations, even with advanced imaging.
- Patients with unresectable gastrinomas have a good prognosis if gastric acid hypersecretion is managed; annual CT scans are recommended for malignancy surveillance.
Conclusions:
- Specialized imaging and surgical expertise are crucial for insulinoma resection.
- Gastrinoma management requires a multidisciplinary approach, focusing on symptom control and surveillance, with surgery reserved for resectable cases.
- Despite localization difficulties, effective management strategies exist for both insulinomas and gastrinomas, leading to favorable long-term outcomes.