Pancreatic insulinomas: diagnostics and pre-operative localization by digital subtraction angiography (DSA)

Prikazana je dijagnostika inzulinoma gušterače te preoperacojska lokalizacija tumora metodom digitalne suptrakcijske angiografije (DSA). Inzulinomi su rijetki tumori gušterače, hormonalno aktivni i u više od 90% slučajeva benigni. Rijetko prelaze veličinu od 2 cm u promjeru. Najčešće su solitarni i nemaju predilekcijskog mjesta u gušterači. S točnom dijagnostikom i točnom prijeoperacijskom lokalizacijom inzulinoma u gušterači postižu se dobri terapijski operacijski rezultati, a time se bitno smanjuje mogućnost mogućih poslijeoperacijskih komplikacija. Prikazujemo šest bolesnika u kojih smo u razdoblju od 1991.-1996. dijagnosticirali inzulinom, od toga su tri muškarca i tri žene. U svih bolesnika se na temelju anamneze, kliničke slike, te biokemijskih nalaza postavila dijagnoza inzulinoma gušterače. Učinjena je angiografija metodom digitalne suptrakcije i nađeni su mali hipervaskularizirani tumori, koji su bili dobro ograničeni od zdravog tkiva gušterače. Tri tumora bila su lokalizirana u glavi, a tri u području trupa gušterače. Pet tumora imalo je vaskularizaciju iz trunkus celijakusa, a jedan iz a. Mezenterike superior. Svi bolesnici bili su operirani, a tumor je odstranjen. Dijagnoza je bila potvrđena histopatološkom analizom. U svih bolesnika metoda digitalne suptrakcijske angiografije pokazala se vrlo sigurnom metodom u prijeoperacijskoj lokalizaciji tumora. Poslijeoperacijski tijek u svih bolesnika bio je uredan i naknadnim kontrolnim pregledima nije se našlo znakova hiperinzulizma.The diagnostic and preoperative localization of the pancreatic insulinoma is shown using the method of digital subtraction angiography (DSA). Insulinoma are very rare pancreatic tumors, hormonally active, in more than 90% benign. In size they rarely excede 2 cm in diameter. Usually they are solitary and do not have predictable site in the pancreas. With a correct diagnostic and preoperative localization of an insulinoma we can achieve good therapeutic results which reduce the possibility of potential postoperative complications. We had six patients, three men and three women. On the basis of their clinical symptoms, biochemical findings and anamnesis pancreatic insulinoma was spected. We performed digital subtraction angiography and found small hypervascular tumors which were separated from the rest of the healthy pancreatic tissue. Three of the tumors were localized in the caput and three in the corpus of the pancreas. Five of them were vascularized from truncus coeliacus and one from a. mesenterica sup. We operated and removed the tumors and the diagnosis was confirmed by the histopathological analysis. Digital subtraction angiography has proven as a very sensitive method in the diagnostic and preoperative localization of pancreatic insulinoma. There was no sign of hyperinsulinism in any of our patients, which was confirmed by later examinations

Pancreatic insulinomas: diagnostics and pre-operative localization by digital subtraction angiography (DSA)

Prikazana je dijagnostika inzulinoma gušterače te preoperacojska lokalizacija tumora metodom digitalne suptrakcijske angiografije (DSA). Inzulinomi su rijetki tumori gušterače, hormonalno aktivni i u više od 90% slučajeva benigni. Rijetko prelaze veličinu od 2 cm u promjeru. Najčešće su solitarni i nemaju predilekcijskog mjesta u gušterači. S točnom dijagnostikom i točnom prijeoperacijskom lokalizacijom inzulinoma u gušterači postižu se dobri terapijski operacijski rezultati, a time se bitno smanjuje mogućnost mogućih poslijeoperacijskih komplikacija. Prikazujemo šest bolesnika u kojih smo u razdoblju od 1991.-1996. dijagnosticirali inzulinom, od toga su tri muškarca i tri žene. U svih bolesnika se na temelju anamneze, kliničke slike, te biokemijskih nalaza postavila dijagnoza inzulinoma gušterače. Učinjena je angiografija metodom digitalne suptrakcije i nađeni su mali hipervaskularizirani tumori, koji su bili dobro ograničeni od zdravog tkiva gušterače. Tri tumora bila su lokalizirana u glavi, a tri u području trupa gušterače. Pet tumora imalo je vaskularizaciju iz trunkus celijakusa, a jedan iz a. Mezenterike superior. Svi bolesnici bili su operirani, a tumor je odstranjen. Dijagnoza je bila potvrđena histopatološkom analizom. U svih bolesnika metoda digitalne suptrakcijske angiografije pokazala se vrlo sigurnom metodom u prijeoperacijskoj lokalizaciji tumora. Poslijeoperacijski tijek u svih bolesnika bio je uredan i naknadnim kontrolnim pregledima nije se našlo znakova hiperinzulizma.The diagnostic and preoperative localization of the pancreatic insulinoma is shown using the method of digital subtraction angiography (DSA). Insulinoma are very rare pancreatic tumors, hormonally active, in more than 90% benign. In size they rarely excede 2 cm in diameter. Usually they are solitary and do not have predictable site in the pancreas. With a correct diagnostic and preoperative localization of an insulinoma we can achieve good therapeutic results which reduce the possibility of potential postoperative complications. We had six patients, three men and three women. On the basis of their clinical symptoms, biochemical findings and anamnesis pancreatic insulinoma was spected. We performed digital subtraction angiography and found small hypervascular tumors which were separated from the rest of the healthy pancreatic tissue. Three of the tumors were localized in the caput and three in the corpus of the pancreas. Five of them were vascularized from truncus coeliacus and one from a. mesenterica sup. We operated and removed the tumors and the diagnosis was confirmed by the histopathological analysis. Digital subtraction angiography has proven as a very sensitive method in the diagnostic and preoperative localization of pancreatic insulinoma. There was no sign of hyperinsulinism in any of our patients, which was confirmed by later examinations

Misleading Presentations of Malignant Breast Diseases – Role of Clinical Cytology

We described two examples with misleading presentations to draw attention to the role of clinical cytology as a part of multidisciplinary approach to breast lesions. In the first case – Paget’s disease of the nipple, there was no obvious clinical and radiological evidence of breast cancer, while the second case – primary non-Hodgkin lymphoma of the breast imitated advanced breast carcinoma. The question is whether accurate and fast diagnoses can be made without cytological examinations. It must be kept in mind that first-hand clinical information and contact with the patient is necessary in rendering accurate cytological diagnoses

Misleading Presentations of Malignant Breast Diseases – Role of Clinical Cytology

We described two examples with misleading presentations to draw attention to the role of clinical cytology as a part of multidisciplinary approach to breast lesions. In the first case – Paget’s disease of the nipple, there was no obvious clinical and radiological evidence of breast cancer, while the second case – primary non-Hodgkin lymphoma of the breast imitated advanced breast carcinoma. The question is whether accurate and fast diagnoses can be made without cytological examinations. It must be kept in mind that first-hand clinical information and contact with the patient is necessary in rendering accurate cytological diagnoses