Arab Journal of Gastroenterology 14 (2013) 186–187
Contents lists available at ScienceDirect
Arab Journal of Gastroenterology journal homepage: www.elsevier.com/locate/ajg
Images in Gastroenterology
Multidetector computed tomography in the diagnosis of insulinoma Abdennasser El Kharras ⇑, Jamal El Fenni, Hassan En-nouali, Ahmed Benkirane Department of Radiology, Hospital Mohamed V, Rabat, Morocco Department of Gastroenterology, Hospital Mohamed V, Rabat, Morocco
a r t i c l e
i n f o
Article history: Received 4 February 2013 Accepted 19 August 2013
a b s t r a c t
Ó 2013 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.
Introduction A 45-year-old woman presented with a 2-year history of recurrent episodes of weakness, blurred vision, confusion, vertigo and headache. The symptoms worsened 1–3 h postprandially and were relieved with eating. There was no previous history of surgery, nor intake of oral hypoglycaemic agents. Serological tests demonstrated low serum glucose levels with high serum insulin levels. On prolonged fasting, serum glucose was 31 mg dl 1, the concurrent plasma insulin level was 54.6 IU ml 1 (reference range: 8.9–28.4 IU ml 1) and the C-peptide level was 6.00 ng ml 1 (refer-
ence range: 1.1–5.0 ng ml 1). She had no family history of diabetes. The physical examination was unremarkable. Precontrast multidetector computed tomography (MDCT, Fig. A) only showed a contour abnormality in the junction of pancreatic head and body. However, in the arterial phase (Fig. B) a well-defined and rounded mass, measuring 16 15 mm, with a typical ring-like enhancement was observed. Endoscopic ultrasound shows a small homogeneous hypoechoic lesion in the head of the pancreas. Gathering the clinical and CT scan findings, insulinoma was the final diagnosis. The patient was referred for a curative surgery. The mass was enucleated. Pathology revealed a well-circumscribed, solid, 16 15-mm mass consistent with insulinoma, with no evidence of pleomorphism, nuclear atypia or adenopathy. Immunocytochemical staining showed 80% insulin-secreting cells (Fig. C). At the 3-month follow-up evaluation this patient became asymptomatic and had normal glucose levels postoperatively.
Figure A. Precontrast computed tomography shows the small mass was isodense to head pancreatic tissue.
⇑ Corresponding author. Address: Im A7, Apt 15, ALEM, Menzeh, Rabat, Morocco. Tel.: +212 663555835. E-mail address: [email protected] (A. El Kharras).
Figure B. Multislice spiral CT scan during early arterial phase shows a hyperdense nodule within the pancreatic parenchyma.
1687-1979/$ - see front matter Ó 2013 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ajg.2013.08.003
A. El Kharras et al. / Arab Journal of Gastroenterology 14 (2013) 186–187
Figure C. Pancreatic endocrine tumor with solid architectural growth patterns (HEx40) Arrow: tumor cells are uniform, round or polygonal with eosinophilic cytoplasm, round nuclei and inconspicuous nucleoli.
Discussion Insulinomas are the most common type of pancreatic endocrine neoplasm accounting for 17% of all islet tumours of the digestive tract. However, these tumours are rare. In the majority of cases (90%), insulinomas are benign and solitary lesions. The majority of insulinomas are located within the pancreas, and there is an equal distribution between the head, body and tail [1]. The clinical diagnosis is based on Whipple’s triad that includes fasting serum glucose
Contents lists available at ScienceDirect
Arab Journal of Gastroenterology journal homepage: www.elsevier.com/locate/ajg
Images in Gastroenterology
Multidetector computed tomography in the diagnosis of insulinoma Abdennasser El Kharras ⇑, Jamal El Fenni, Hassan En-nouali, Ahmed Benkirane Department of Radiology, Hospital Mohamed V, Rabat, Morocco Department of Gastroenterology, Hospital Mohamed V, Rabat, Morocco
a r t i c l e
i n f o
Article history: Received 4 February 2013 Accepted 19 August 2013
a b s t r a c t
Ó 2013 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.
Introduction A 45-year-old woman presented with a 2-year history of recurrent episodes of weakness, blurred vision, confusion, vertigo and headache. The symptoms worsened 1–3 h postprandially and were relieved with eating. There was no previous history of surgery, nor intake of oral hypoglycaemic agents. Serological tests demonstrated low serum glucose levels with high serum insulin levels. On prolonged fasting, serum glucose was 31 mg dl 1, the concurrent plasma insulin level was 54.6 IU ml 1 (reference range: 8.9–28.4 IU ml 1) and the C-peptide level was 6.00 ng ml 1 (refer-
ence range: 1.1–5.0 ng ml 1). She had no family history of diabetes. The physical examination was unremarkable. Precontrast multidetector computed tomography (MDCT, Fig. A) only showed a contour abnormality in the junction of pancreatic head and body. However, in the arterial phase (Fig. B) a well-defined and rounded mass, measuring 16 15 mm, with a typical ring-like enhancement was observed. Endoscopic ultrasound shows a small homogeneous hypoechoic lesion in the head of the pancreas. Gathering the clinical and CT scan findings, insulinoma was the final diagnosis. The patient was referred for a curative surgery. The mass was enucleated. Pathology revealed a well-circumscribed, solid, 16 15-mm mass consistent with insulinoma, with no evidence of pleomorphism, nuclear atypia or adenopathy. Immunocytochemical staining showed 80% insulin-secreting cells (Fig. C). At the 3-month follow-up evaluation this patient became asymptomatic and had normal glucose levels postoperatively.
Figure A. Precontrast computed tomography shows the small mass was isodense to head pancreatic tissue.
⇑ Corresponding author. Address: Im A7, Apt 15, ALEM, Menzeh, Rabat, Morocco. Tel.: +212 663555835. E-mail address: [email protected] (A. El Kharras).
Figure B. Multislice spiral CT scan during early arterial phase shows a hyperdense nodule within the pancreatic parenchyma.
1687-1979/$ - see front matter Ó 2013 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ajg.2013.08.003
A. El Kharras et al. / Arab Journal of Gastroenterology 14 (2013) 186–187
Figure C. Pancreatic endocrine tumor with solid architectural growth patterns (HEx40) Arrow: tumor cells are uniform, round or polygonal with eosinophilic cytoplasm, round nuclei and inconspicuous nucleoli.
Discussion Insulinomas are the most common type of pancreatic endocrine neoplasm accounting for 17% of all islet tumours of the digestive tract. However, these tumours are rare. In the majority of cases (90%), insulinomas are benign and solitary lesions. The majority of insulinomas are located within the pancreas, and there is an equal distribution between the head, body and tail [1]. The clinical diagnosis is based on Whipple’s triad that includes fasting serum glucose
