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Updated: Dec 10, 2025
Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head
Published on: January 3, 2020
Comparison of benign and malignant insulinoma
Alaa Sada1, Thomas Szabo Yamashita2, Amy E Glasgow3
1Department of Surgery, Mayo Clinic, 200th 1st Street, Rochester MN, 55905, USA; Department of Health Services Research, Mayo Clinic, 200th 1st Street, Rochester MN, 55905, USA.
Background:
How malignant insulinomas present relative to benign insulinomas is unknown.
Methods:
A single-institution retrospective study identified patients with insulinoma. Malignancy was defined by distant metastases, positive lymph node(s), T stage of 4, direct invasion into surrounding peripancreatic tissue, or presence of lymphovascular invasion. Wilcoxon Rank Sum tests and Kaplan-Meier analysis were used.
Results:
A total of 311 patients were identified: 51 malignant and 260 benign. Patients with malignant insulinoma presented with higher levels of insulin, proinsulin, and c-peptide. Malignant lesions were larger: 4.2 ± 3.2 vs 1.8 ± 0.8 cm in benign lesions, p < 0.01. Overall survival at 5 years was 66.8% vs 95.4% for malignant and benign insulinoma respectively, p < 0.01.
Conclusions:
Larger size of insulinoma and increased serum β-cell polypeptide concentrations were associated with malignancy. Malignant insulinoma has poorer survival. Further work-up to rule out malignancy may be indicated for larger pancreatic lesions and for patients with higher pre-operative insulin and pro-insulin.
