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The Pancreatic Endocrine Tumors - Experience of First Surgical Clinic Iasi.
Chirurgia (Bucur). 2019 Sept-Oct; 114(5):639-649.C

Abstract

Pancreatic neuroendocrine tumors (PNETs) are rare and characterized by widely variable clinical presentation and often challenging surgical management.

Methods:

Retrospective study conducted during the last 15 years at the First Surgical Clinic of the Iasi St Spiridon University Hospital, and which included all the patients diagnosed with pancreatic endocrine tumors by immunohistochemistry.

Results:

There were 26 cases diagnosed with PNET. The male/female ratios was 7/19 and mean age 41.93 +- 2.48 years (range 20-79 years). Of the PNET cases 13 were insulinomas, 5 gastrinomas, 2 gastrinomas associated with other endocrine neoplasms (Wermer syndrome), 5 non-functional endocrine pancreatic tumors and 1 ACTHoma. Clinical manifestations depended on tumor type: hypoglycemia and Whipple triad for insulinoma, Zollinger Ellison syndrome and complicated peptic ulcer (hemorrhage, perforation) for gastrinoma, Cushing syndrome for ACTHoma. Biological diagnosis included biological markers (e.g. insulin, gastrin and cortisol). Tumor site and size at diagnosis were determined by ultrasound, CT-scan, angiography, PETscan, octreoscan and intraoperative ultrasound. Surgical procedures for PNET insulinomas were: tumor resection - 6 cases; left splenopancreatectomy - 3 cases; left spleen-preserving pancreatectomy - 2 cases; pancreaticoduodenectomy - 2 cases. We also present 4 cases of gastrinoma with multiple ulcers and multiple surgical interventions for hemorrhage and perforation with peritonitis. The two patients with Wermer syndrome also had ulcers complicated with hemorrhage and peritonitis and parathyroid adenoma. Nonfunctional pancreatic endocrine tumors were diagnosed in 5 women of which in 3 the tumors were located in the pancreatic tail (in which splenopancreatectomy and left pancreatectomy with spleen preservation were performed) and in 2 in the pancreatic head (in which pancreaticoduodenectomy and Beger type operation were performed).

Conclusions:

Knowledge of clinical signs of secreting tumors and exploring the patients are of crucial importance for management of PNETs. Immunohistochemistry is mandatory for confirming the diagnosis and assessing the proliferation and biological behavior of the tumor, thus facilitating the administration of specific therapy. Aggressive surgical treatment is indicated, even in advanced stages.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31670640

Citation

Târcoveanu, Eugen, et al. "The Pancreatic Endocrine Tumors - Experience of First Surgical Clinic Iasi." Chirurgia (Bucharest, Romania : 1990), vol. 114, no. 5, 2019, pp. 639-649.
Târcoveanu E, Lupascu C, Vasilescu A, et al. The Pancreatic Endocrine Tumors - Experience of First Surgical Clinic Iasi. Chirurgia (Bucur). 2019;114(5):639-649.
Târcoveanu, E., Lupascu, C., Vasilescu, A., Moldovanu, R., Andronic, D., Ciobanu, D., & Bradea, C. (2019). The Pancreatic Endocrine Tumors - Experience of First Surgical Clinic Iasi. Chirurgia (Bucharest, Romania : 1990), 114(5), 639-649. https://doi.org/10.21614/chirurgia.114.5.639
Târcoveanu E, et al. The Pancreatic Endocrine Tumors - Experience of First Surgical Clinic Iasi. Chirurgia (Bucur). 2019 Sept-Oct;114(5):639-649. PubMed PMID: 31670640.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Pancreatic Endocrine Tumors - Experience of First Surgical Clinic Iasi. AU - Târcoveanu,Eugen, AU - Lupascu,Cristian, AU - Vasilescu,Alin, AU - Moldovanu,Radu, AU - Andronic,Dan, AU - Ciobanu,Delia, AU - Bradea,Costel, PY - 2019/10/01/accepted PY - 2019/11/1/entrez PY - 2019/11/2/pubmed PY - 2019/11/15/medline KW - Wermersyndrome KW - Zollinger-Ellisonsyndrome KW - gastrinoma KW - insulinoma KW - pancreatectomy KW - pancreaticendocrinetumors SP - 639 EP - 649 JF - Chirurgia (Bucharest, Romania : 1990) JO - Chirurgia (Bucur) VL - 114 IS - 5 N2 - Pancreatic neuroendocrine tumors (PNETs) are rare and characterized by widely variable clinical presentation and often challenging surgical management. Methods: Retrospective study conducted during the last 15 years at the First Surgical Clinic of the Iasi St Spiridon University Hospital, and which included all the patients diagnosed with pancreatic endocrine tumors by immunohistochemistry. Results: There were 26 cases diagnosed with PNET. The male/female ratios was 7/19 and mean age 41.93 +- 2.48 years (range 20-79 years). Of the PNET cases 13 were insulinomas, 5 gastrinomas, 2 gastrinomas associated with other endocrine neoplasms (Wermer syndrome), 5 non-functional endocrine pancreatic tumors and 1 ACTHoma. Clinical manifestations depended on tumor type: hypoglycemia and Whipple triad for insulinoma, Zollinger Ellison syndrome and complicated peptic ulcer (hemorrhage, perforation) for gastrinoma, Cushing syndrome for ACTHoma. Biological diagnosis included biological markers (e.g. insulin, gastrin and cortisol). Tumor site and size at diagnosis were determined by ultrasound, CT-scan, angiography, PETscan, octreoscan and intraoperative ultrasound. Surgical procedures for PNET insulinomas were: tumor resection - 6 cases; left splenopancreatectomy - 3 cases; left spleen-preserving pancreatectomy - 2 cases; pancreaticoduodenectomy - 2 cases. We also present 4 cases of gastrinoma with multiple ulcers and multiple surgical interventions for hemorrhage and perforation with peritonitis. The two patients with Wermer syndrome also had ulcers complicated with hemorrhage and peritonitis and parathyroid adenoma. Nonfunctional pancreatic endocrine tumors were diagnosed in 5 women of which in 3 the tumors were located in the pancreatic tail (in which splenopancreatectomy and left pancreatectomy with spleen preservation were performed) and in 2 in the pancreatic head (in which pancreaticoduodenectomy and Beger type operation were performed). Conclusions: Knowledge of clinical signs of secreting tumors and exploring the patients are of crucial importance for management of PNETs. Immunohistochemistry is mandatory for confirming the diagnosis and assessing the proliferation and biological behavior of the tumor, thus facilitating the administration of specific therapy. Aggressive surgical treatment is indicated, even in advanced stages. SN - 1221-9118 UR - https://www.unboundmedicine.com/medline/citation/31670640/The_Pancreatic_Endocrine_Tumors_-_Experience_of_First_Surgical_Clinic_Iasi L2 - http://revistachirurgia.ro/pdfs/2019-5-639.pdf DB - PRIME DP - Unbound Medicine ER -