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

INTRODUCTIONGiant pancreatic insulinomas are rare endocrine tumors. We describe 2 cases reviewing the current literature.PRESENTATION OF CASEWe report herein 2 female patients affected by giant insulinomas of 14 cm and 6 cm, 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.DISCUSSIONUp to now only 7 cases have been reported previously. Insulinomas larger than 3 cm 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.CONCLUSIONOne of the cases here described (14 cm) is the largest presented in the literature. Despite the size, giant insulinoma is related apparently neither to metastases nor to the recurrences.