A Report of Multiple Insulinoma with Different Image Findings

Tetsushi Hayakawa, Nagao Shinagawa, Akihiko Iwai, Yuji Okada*, Hiroshi Mizuno*, Jiro Yura

The First Department of Surgery, Nagoya City University Medical School
*Department of Surgery, Chita Kousei Hospital

Insulinoma is generally an indication for surgery, but it is sometimes multiple in origin, making exact resection difficult. We have recently experienced a case of multiple insulinoma appearing in different locations according to various examinations. The patient is a 26-year-old woman who presented with Whipple's triad, suggesting an insulinoma. Its location was shown to be at the body of the pancreas by celiac arteriography, and at the head of the pancreas by ultrasonograpy and ultraendoscopy. Ca²⁺-loading percutaneous transhepatic portal venous sampling (Ca²⁺PTPVS) gave results suggestive of its presence at both the head and the body of the pancreas. At laparotomy, tumors were found in both of these regions, and they were resected. Histological examination confirmed that both tumors were insulinomas, and the one at the body was rich in vessels, in contrast to the one at the head which showed strong vitreous degeneration. The different image diagnoses obtained before and after the operation seem to have been responsible for this histological difference.

Key words
insulinoma, multicentric insulinoma, percutaneous transhepatic portal venous sampling

Reprint requests
Tetsushi Hayakawa The First Department of Surgery, Nagoya City University Medical School
1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467 JAPAN

Accepted
May 9, 1990

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