THE FIRST EXPERIENCE OF CONTRAST ENHANCED ENDOSONOGRAPHY IN CONTROVERSIAL DIAGNOSIS CASE OF PANCREATIC INSULINOMA

Since October 2015 we have started to use contrast-enhanced endoscopic ultrasound (CE EUS) in some patients, among them there were two patients with insulinomas. One patient with unknown origin hypoglycemia was interesting from the diagnostic viewpoint. The laboratory diagnostic problems were related to the fact that the tumor almost did not produce insulin. Just detecting hyperproinsulinaemia we managed to prove the endogenous hyperinsulinism. At topical diagnosis CE EUS was the only one method detected hyper-vascularized tumor in pancreatic isthmus. The tumor was successfully enucleated laparoscopically. Immunohistochemical study confirmed neuroendocrine tumor with predominant production of proinsulin. Normoglycemia was defined at two-month follow-up

contrast-enhanced endoscopic ultrasound, insulinoma, proinsulin, immunohistochemistry, enucleation, EUS

1. Grant C. S. Surgical aspects of hyperinsulinemic hypoglycemia //Endocrinology and metabolism clinics of North America. - 1999. - Т. 28. - №. 3. - С. 533-554.

2. Chatziioannou A. et al. Imaging and localization of pancreatic insulinomas //Clinical imaging. - 2001. - Т. 25. - №. 4. - С. 275-283.

3. Thompson G. B. et al. Reoperative insulinomas, 1927 to 1992: an institutional experience //Surgery. - 1993. - Т. 114. - №. 6. - С. 1196-204; discussion 1205-6.

4. Simon D. et al. Reoperative surgery for organic hyperinsulinism: indications and operative strategy //World journal of surgery. - 1998. - Т. 22. - №. 7. - С. 666-672.

5. Дедов И. И., Кривко А. А., Силина Т. Л., Кузнецов Н. С., Трошина Е. А. Методические рекомендации. «Инсулинома». Москва. 2013, издательство «Адаманть» 45 с.

6. Дедов И. И., Мельниченко Г. А., Пронин В. С. и соавт. Клиника и диагностика эндокринных нарушений - М: Триада - 2005 г.

7. Лавин Эндокринология - М: Практика -1999 г.

8. Кузин Н. М., Егоров А. В. Нейроэндокринные опухоли поджелудочной железы. - М.: Медицина- 2001 г.

9. Майстренко Н. А., Курыгин А. А., Хижа В. В. Диагностика и лечение инсулиномы //Анналы хирургической гепатологии. - 2010. - Т. 3. - С. 11.

10. Richards M. L. et al. Pitfalls in the surgical treatment of insulinoma //Surgery. - 2002. - Т. 132. - №. 6. - С. 1040-1049.

11. Hiramoto J. S. et al. Intraoperative ultrasound and preoperative localization detects all occult insulinomas //Archives of Surgery. - 2001. - Т. 136. - №. 9. - С. 1020-1026.

12. Силина Т. Л. и др. Эндосонография в предоперационной диагностике инсулином //Эндокринная хирургия. - 2007. - №. 1. - С. 19-23.

13. Силина Т. Л. и др. Задачи и возможности эндоскопического ультразвукового исследования в дооперационной топической диагностике инсулином поджелудочной железы //Экспериментальная и клиническая гастроэнтерология. - 2011. - №. 10.

14. Silina T. et al. Endoscopic Ultrasound of 66 Insulinomas //Neuroendocrinology. - Allschwilerstrasse10, Ch-4009 Basel, Switzerland: Karger, 2010. - Т. 92. - №. 1. - С. 58-58.

15. Silina T. et al. Mathematical method for objective estimation of endoscopic ultrasound images of pancreatic insulinomas //Gastrointestinal Endoscopy. - 2009. - Т. 69. - №. 2. - С. S257.

16. Silina T. The Statistical Analysis of the EUS-Features of Insulinomas //Endoscopy. - 2011. - Т. 43. - №. S03. - С. A122.

17. Ishikawa T. et al. Usefulness of EUS combined with contrast-enhancement in the differential diagnosis of malignant versus benign and preoperative localization of pancreatic endocrine tumors //Gastrointestinal endoscopy. - 2010. - Т. 71. - №. 6. - С. 951-959.