Successful Treatment of Benign Insulinoma by Transcatheter Angioembolization

Abstract

Background/objective: Evidence on the efficacy and safety of minimally invasive treatment for insulinoma has increased over the past decade to the point of becoming a recommendation in clinical practice guidelines for the management of this type of neuroendocrine tumor.

Case report: We describe the case of an elderly male patient with multiple comorbidities and recurrent isolated insulinoma of 3.7 × 3.5 cm involving the uncinate process of the pancreas and contacting the splenomesenteric confluent many years after first resection, in whom, after refusing surgical management, was performed as successful arterial embolization of the pancreatic tumor.

Discussion: When addressing this pathology, it is common to encounter patients who are not candidates for surgical management, either due to the presence of comorbidities, the location of the tumor in relation to vascular structures, or refusal of the intervention. Therefore, it is important to be aware of the different therapeutic options in localized and metastatic disease.

Conclusion: Minimally invasive procedures are positioned as an effective alternative for the treatment of the hormonal overproduction in patients with insulinoma.

Keywords: angioembolization; insulinoma; neuroendocrine tumor.

Figure 1

Abdominal magnetic resonance imaging (MRI). Solid lesion with a neoplastic appearance measuring 3.7 × 3.5 cm in the axial plane, with heterogeneous signal intensity, predominantly hyperintense on T2, slightly hyperintense on T1, located in the uncinate process of the pancreas. It causes diffusion restriction and presents early arterial enhancement after the administration of contrast medium.

Figure 2

Abdominal angiography. A. Initial arteriography and selective arterial catheterization, where tumor blush is observed. (Pre-embolization, red arrow) B. Postembolization arteriography, visualization of arteries with absence of tumor blush (green arrow).