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Giant Insulinoma: Case Report and Review of the Literature

Department of Surgery, Uniformed Services University of the Health Sciences (E.A.M.), Bethesda, Maryland 20762; and Departments of Pathology (Y.-C.L.) and Surgery (C.R.M.), MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio 44109

Address all correspondence and requests for reprints to: Dr. Christopher R. McHenry, Department of Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, Ohio 44109. E-mail: cmchenry{at}metrohealth.org.

An insulinoma is a rare pancreatic endocrine tumor that is typically sporadic, solitary, and less than 2 cm in diameter. Fewer than 5% of insulinomas are larger than 3 cm. Ninety percent or more of all insulinomas are benign. Larger tumors are more likely to be malignant. We report a case of a giant pedunculated insulinoma, measuring 9 cm in diameter and weighing 100 g, with amyloid deposits accounting for 70% of the tumor volume. At the time of operation, no local invasion or metastatic disease was identified. On pathological evaluation, the tumor was classified as an insulinoma of uncertain biological behavior. In addition to describing the clinical presentation and operative findings, criteria for determining malignancy are outlined, a detailed pathological description is presented, and the 2000 World Health Organization Classification for Pancreatic Endocrine Neoplasms is reviewed.