Concurrent insulinoma and pancreatic adenocarcinoma: report of a rare case and review of the literature

Pancreatic adenocarcinoma is the 5th leading cause of cancer-related death in Western countries and insulinomas are rare endocrine neoplasms of the pancreas. The concurrent appearance of pancreatic adenocarcinoma and insulinoma is very rare and to the best of our knowledge has never been reported again. Herein, we present such an occurrence in a 74-year-old man. Resection of a mass in the uncinate process of the pancreas revealed pancreatic adenocarcinoma with severe desmoplastic reaction. Two years later, due to symptomatology persistence the patient was re-examined and a new 2cm mass in the uncinate process was found leading to surgery, which demonstrated a 2cm endocrine islet-cell tumor. Establishing a diagnosis in patients with insulinoma is difficult and the imaging studies still have low sensitivity and specificity except for intra-operative ultrasonography, which is the most accurate method detecting 90% of these lesions

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Insulinomas do pâncreas: diagnóstico e tratamento Pancreatic insulinomas: diagnosis and treatment

RACIONAL: O insulinoma é uma neoplasia que pertence ao grupo de tumores neuroendócrinos do pâncreas; embora raro, é o mais freqüente entre eles. OBJETIVO: Avaliar os resultados clínico e imunohistoquímico de doentes com insulinoma de pâncreas submetidos a tratamento cirúrgico. PACIENTES E MÉTODOS: Foram detalhados o quadro clínico, exames laboratoriais e de imagem, dando ênfase aos aspectos cirúrgicos, complicações e acompanhamento, a médio e longo prazos, de 12 doentes portadores de insulinoma. A cirurgia foi indicada para todos, com base nas evidências clínicas e laboratoriais de hipoglicemia e hiperinsulinemia. RESULTADOS: Em sete doentes conseguiu-se a localização prévia da lesão; em cinco, sua localização foi identificada durante a cirurgia mediante palpação e através do ultra-som intra-operatório. O procedimento mais freqüentemente utilizado foi a ressecção pancreática em oito doentes. A complicação cirúrgica mais freqüente foi a fístula pancreática, observada em sete doentes. Dois apresentaram tardiamente diabetes mellitus. Não houve mortes na presente casuística. CONCLUSÃO: Na totalidade dos doentes obteve-se a reversão clínica dos sintomas, caracterizada pelo desaparecimento da tríade de Whipple, além de normalização ou aumento dos níveis de glicemia, quando comparados aos valores do pré-operatório.<br>BACKGROUND: Despite its rarity, the insulinoma is the most common pancreatic neuroendocrine tumor. OBJECTIVE: Analyze clinical and immunohistochemical data from surgical resection of the pancreas insulinoma. METHOD: Twelve cases are described, concerning surgical aspects, complications and medium-long term outcome of patients. They underwent surgical treatment due to clinical suspicion and biochemical diagnosis of hypoglycemia and hyperinsulinism. RESULTS: The insulinoma was identified preoperatively in seven patients, while intraoperative ultrasonography and palpation were necessary for diagnosis in the other cases. Eight patients underwent pancreatic resection and pancreatic leak was observed in seven cases. Two patients developed diabetes mellitus and no mortality occurred in the current series. CONCLUSION: All patients presented satisfactory outcome and remained asymptomatic with normal glicemia levels