Giant pancreatic insulinoma. The bigger the worse? Report of two cases and literature review

Abstract

INTRODUCTION: Giant pancreatic insulinomas are rare endocrine tumors. We describe 2 cases reviewing the current literature. PRESENTATION OF CASE: We report herein 2 female patients affected by giant insulinomas of 14cm and 6cm, respectively. Symptomatic hypoglycemia episodes occurred during 4 months in first case and 3 years in the second one until diagnosis. Both patients were successfully treated performing a distal pancreatectomy with splenic preservation in the first case and a Whipple's procedure in the second one. DISCUSSION: Up to now only 7 cases have been reported previously. Insulinomas larger than 3cm accounts for less than 5% of all. This literature review shows that despite the size hypoglycemic symptoms varies from 1 day to 3 years and only 1 out of 9 cases reported presented lymph nodes metastases. No recurrences have been described. CONCLUSION: One of the cases here described (14cm) is the largest presented in the literature. Despite the size, giant insulinoma is related apparently neither to metastases nor to the recurrences.