A Case of Multiple Pancreatic Insulinoma Laparoscopically Resected through Precise Spatial Diagnosis by SACI Test

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Introduction: Case: A 58-year-old man representing cold sweat, palpitation and nausea was admitted to our hospital and was pointed out parathyroid, pancreatic and superior mediastinal masses with CT.

Aim(s): The pancreatic and mediastinal masses were diagnosed as neuroendocrine tumor by EUS-FNA. Because of the high serum intact PTH, we suspected multiple endocrine neoplasia type 1 and he gradually showed frequent symptom of hypoglycemia.

Materials and methods: Dynamic CT scan showed five masses spreading from body to tail of the pancreas and EUS showed suspicious lesions in the pancreatic head. FDG-PET and DOTATOC-PET studies showed multiple hot spots all through the pancreas with no evidence of liver metastases. To identify the localization of lesions secreting insulin, we performed the selective arterial calcium injection(SACI) test. SACI test showed increased insulin secretion at the proximal and distal site of splenic artery, indicating that the responsible lesions resided in the pancreas body and tail, but not in the pancreas head.

Conference: 13th Annual ENETSConcerence (2016)

Presenting Author:

Authors: Nakano K, Masui T, Sato A, Ito T, Anazawa T,

Keywords: insulinoma, SACI test, MEN1,