Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
3317279 | Pancreatology | 2014 | 4 Pages |
Abstract
Insulinomas represent the most common functional neuroendocrine tumor of the pancreas. They are usually solitary, benign, well differentiated (G1/G2) and curable by surgery. We describe the case of a 45 year old male Caucasian with a unique malignant, metastasized pancreatic insulinoma (Ki 67 of 70%, G3). To control excessive insulin production emanating in refractory hypoglycemia and growth of the highly proliferating tumor a multimodal therapeutic approach including the consecutive use of tumor debulking surgery, chemotherapy, TACE, SIRT, PRRT as well as a drug therapy with diazoxide, somatostatin analogs and everolimus was employed. Chemotherapy with carboplatin/etoposide plus everolimus provided the longest normoglycemic period. After progress chemotherapy with dacarbazine had the most positive effect, while debulking approaches such as surgery and liver directed therapies, as well as PRRT were less efficient with only transient success.
Keywords
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Gastroenterology
Authors
Michael Scharf, Daniela Mueller, Ute Koenig, Andreas Pfestroff, Wilhelm Nimphius, Jens Figiel, Anja Rinke, Alexander Koenig, Thomas Gress,