Nonfunctioning islet cell tumors of the pancreas: A difficult diagnosis but one worth the effort

James A. Madura, Oscar W. Cummings, Eric A. Wiebke, Thomas A. Broadie, Robert L. Goulet, Thomas J. Howard

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Islet cell tumors of the pancreas usually secrete gastroenteropancreatic peptides causing well-recognized clinical syndromes. Description of these syndromes and the identification of the responsible hormones by radioimmunoassay has led to a better understanding of neuroendocrine regulatory function. More recently, similar tumors have been seen that contain various peptides on immunohistochemical stain but do not secrete these substances sufficiently to cause clinical symptoms. Nonetheless, they have the same malignancy and metastatic rate as most of the functional tumors. Between 1972 and 1996, 44 patients with islet cell tumors have been treated at the Indiana University Medical Center Hospital, and of these 14 have been nonfunctional. Preoperative imaging studies, such as CT scan and endoscopic ultrasound, were able to visualize a lesion but not to make the specific diagnosis, even with fine-needle aspiration. Pancreatic ductal preservation on endoscopic retrograde cholangiopancreatography with CT evidence of a mass should arouse suspicion of an islet cell tumor. Once discovered, all but 1 of the 14 patients has undergone resective therapy, with only 1 postoperative death. Treatment has been aggressive, with 11 of the 13 resected patients undergoing pancreaticoduodenectomy, and 2 others distal pancreatectomy. Four of the seven patients with positive lymph node metastases are dead, while all patients with negative nodes are still alive. Thus far, 10 of the original 14 patients are alive, surviving an average of 32.7 months, with a median survival of 31.1 months. Because these tumors have a better overall prognosis, vigorous attempts at total or subtotal resection should be carried out, since the long-term survival is enhanced by tumor bulk reduction or curative resection when possible.

Original languageEnglish (US)
Pages (from-to)573-578
Number of pages6
JournalAmerican Surgeon
Volume63
Issue number7
StatePublished - Jul 1 1997

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Islet Cell Adenoma
Pancreas
Neoplasms
Peptides
Pancreatectomy
Pancreaticoduodenectomy
Survival
Endoscopic Retrograde Cholangiopancreatography
Fine Needle Biopsy
Radioimmunoassay
Coloring Agents
Lymph Nodes
Hormones
Neoplasm Metastasis
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Nonfunctioning islet cell tumors of the pancreas : A difficult diagnosis but one worth the effort. / Madura, James A.; Cummings, Oscar W.; Wiebke, Eric A.; Broadie, Thomas A.; Goulet, Robert L.; Howard, Thomas J.

In: American Surgeon, Vol. 63, No. 7, 01.07.1997, p. 573-578.

Research output: Contribution to journalArticle

Madura, James A. ; Cummings, Oscar W. ; Wiebke, Eric A. ; Broadie, Thomas A. ; Goulet, Robert L. ; Howard, Thomas J. / Nonfunctioning islet cell tumors of the pancreas : A difficult diagnosis but one worth the effort. In: American Surgeon. 1997 ; Vol. 63, No. 7. pp. 573-578.
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