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Sakamoto A, Ogawa K, Iwata M, Ito C, Shine M, Matsui T, Nishi Y, Uraoka M, Utsunomiya T, Nagaoka T, Tamura K, Funamizu N, Inoue H, Sakamoto K, Kurata M, Takada Y. Intraoperative selective arterial calcium injection test to confirm complete resection of a proinsulinoma. J Surg Case Rep 2022; 2022:rjac249. [PMID: 35919694 PMCID: PMC9341228 DOI: 10.1093/jscr/rjac249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/07/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Proinsulinoma is a subtype of insulinoma that is surgically curable, but localization can be difficult as these tumors are typically too small to be visualized by imaging. We report the case of a 53-year-old woman referred to our hospital with dizziness and headache. Her blood glucose level was 46 mg/dl and Whipple’s triad was present. Although her immunoreactive insulin level during hypoglycemia was in the normal range (5.0 μU/ml), the proinsulin level was elevated (408 pmol/l). Imaging examinations showed no evidence of pancreatic tumor. A preoperative selective arterial calcium injection (SACI) test showed excessive insulin secretion in the splenic artery region, which localized the proinsulinoma to the body or tail of the pancreas, and laparoscopic spleen-preserving distal pancreatectomy was performed. Intraoperative SACI test performed after tumor removal did not show excessive insulin secretion. The intraoperative SACI test appears to be useful for localization and for confirming complete resection of proinsulinoma.
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Affiliation(s)
- Akimasa Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Kohei Ogawa
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Miku Iwata
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Chihiro Ito
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Mikiya Shine
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Takashi Matsui
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Yusuke Nishi
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Mio Uraoka
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Takeshi Utsunomiya
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Tomoyuki Nagaoka
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Kei Tamura
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Naotake Funamizu
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Hitoshi Inoue
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Katsunori Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Mie Kurata
- Department of Pathology , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
| | - Yasutsugu Takada
- Department of Hepato-Biliary-Pancreatic and Breast Surgery , , Toon City, Ehime, Japan
- Ehime University Graduate School of Medicine , , Toon City, Ehime, Japan
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