Insulinoma pancreatico occulto: chirurgia radio-guidata con 111 In-octreotide. Case report e revisione della letteratura in tema di diagnosi pre ed intraoperatoria

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COD: 2000_01_107-114 Categorie: ,

G. Ressetta, O. Geatti, B. Pozzetto, M. Sustersich, M. Povolato, G. Ferretti, A. Leggeri

Ann. Ital. Chir., LXXI, 1, 2000

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Introduction: pancreatic insulinoma is a small, rare neoplasm; its radical therapy is surgical enucleation or resection. Although clinical diagnosis is simple, instrumental and radiological localization is still difficult (occult insulinoma: 10-20%). Material and methods: the authors present the case of a 71- year-old patient suffering from relapsing vertigo syndrome, derangement and transient lypothymia after strong physical activity. ECG, encephalic and abdominal C.T., eco-color- Doppler of epiaortic vessels failed to identify any pathological features. Laboratory tests only revealed that basal glycemia was always lower than normal. Insulinoma was strongly suspected following the outcome of dosages of insulina and C-peptide in the serum and was confirmed after a supervised fast test (72 h). Once the biochemical diagnosis had been reached an abdominal eco, C.T., a selective and superselective angiography and ecoendoscopy were carried out to locate the tumor site but results were negative. Only somatostatinreceptor- scintigraphy with 111 In-octreotide detected a catchment area (diameter: 3 cm) to the right of the hypochondrium, anterior to the kidney and caudal to the left hepatic lobe.