Insulinoma classification: Difference between revisions
Line 28: | Line 28: | ||
**Multiple | **Multiple | ||
***90% of insulinoma are solitary while 10% can be multiple in number | ***90% of insulinoma are solitary while 10% can be multiple in number | ||
*It may be classified into 2 subtypes based on the functionality: | *It may be classified into 2 subtypes based on the functionality(clinical manifestations): | ||
**Functional | **Functional | ||
**Non-functional<ref name="pmid15522939">{{cite journal| author=Mittendorf EA, Liu YC, McHenry CR| title=Giant insulinoma: case report and review of the literature. | journal=J Clin Endocrinol Metab | year= 2005 | volume= 90 | issue= 1 | pages= 575-80 | pmid=15522939 | doi=10.1210/jc.2004-0825 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15522939 }} </ref> | **Non-functional<ref name="pmid15522939">{{cite journal| author=Mittendorf EA, Liu YC, McHenry CR| title=Giant insulinoma: case report and review of the literature. | journal=J Clin Endocrinol Metab | year= 2005 | volume= 90 | issue= 1 | pages= 575-80 | pmid=15522939 | doi=10.1210/jc.2004-0825 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15522939 }} </ref> |
Revision as of 20:35, 14 August 2017
Insulinoma Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Insulinoma classification On the Web |
American Roentgen Ray Society Images of Insulinoma classification |
Risk calculators and risk factors for Insulinoma classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
Insulinoma may be classified according to into malignant potential into 2 sub-types: Benign(90%)and Malignant(10%) Insulinoma is also classified into 2 subtypes based on the number: Solitary(90%) and Multiple(10%). Previously insulinoma was classified into 2 subtypes based on hormonal level as determined by radioimmunoassay into Group A and Group B. The staging of malignant Insulinoma is based on the AJCC 2010, ENETS and modified ENETS staging classification
Classification
- Insulinoma may be classified according to malignant potential into 2 sub-types:
- Benign
- Malignant
- 90% of insulinoma are benign in nature while 10% has a malignant potential to invade adjacent soft tissues or structures. The malignant type is mostly associated with MEN 1 syndrome.They also have a recurrence rate which is higher in those with MEN1 (21% at 10 and 20 years) than without it(5% at 10 and 7% at 20 years).[1] In one of the recent research papers, the recurrence was described as 4 times more common in individuals with MEN 1.[2]
- Insulinoma is also classified into 2 subtypes based on the number:
- Solitary
- Multiple
- 90% of insulinoma are solitary while 10% can be multiple in number
- It may be classified into 2 subtypes based on the functionality(clinical manifestations):
- Functional
- Non-functional[3]
- Previously insulinoma was classified into 2 subtypes based on hormonal level as determined by radioimmunoassay[4]:
- Group A of abundant B cells with trabecular arrangement and uniform insulin immunofluorescence
- Group B of scarce B cells with medullary arrangement and irregular immunofluorescence
- The staging of malignant insulinoma being a pancreatic neuroendocrine tumor may be classified into several subtypes based on American Joint Cancer Committee(AJCC) 7th edition 2010 [5][6] :
Stage | T | N | M |
IA | T1 | N0 | M0 |
IB | T2 | N0 | M0 |
IIA | T3 | N0 | M0 |
IIB | T1-3 | N1 | M0 |
III | T4 | Any N | M0 |
IV | Any T | Any N | M1 |
T | T1 | <2 cm in greatest dimension |
---|---|---|
T2 | >2 cm in greatest dimension | |
T3 | Beyond the pancreas but without involvement of the superior mesenteric artery | |
T4 | Involvement of the celiac axis or superior mesenteric artery(unresectable tumor) | |
N | N0 | No regional lymph node metastasis |
N1 | Regional lymph node metastasis | |
M | M0 | No distant metastasis |
M1 | Distant metastasis |
- Being a pancreatic neuroendocrine tumor, it is also staged by European Neuroendocrine Tumor Society (ENETS)as [5][6]:
Stage | T | N | M |
I | T1 | N0 | M0 |
IIA | T2 | N0 | M0 |
IIB | T3 | N0 | M0 |
IIIA | T4 | N0 | M0 |
III B | Any T | N1 | M0 |
IV | Any T | Any N | M1 |
T | T1 | Tumor limited to pancreas,<2 cm |
---|---|---|
T2 | Tumor limited to pancreas,2-4 cm | |
T3 | >4cm, or invading the duodenum or common bile duct | |
T4 | Tumor invades adjacent structures | |
N | N0 | No regional lymph node metastasis |
N1 | Regional lymph node metastasis | |
M | M0 | No distant metastasis |
M1 | Distant metastasis |
- In its new 8th edition of AJCC which is planned to be published on January 1, 2018; AJCC[5] had developed a modified ENETS(mENETS) staging classification:
Stage | T | N | M |
IA | T1 | N0 | M0 |
IB | T2 | N0 | M0 |
IIA | T3 | N0 | M0 |
IIB | T1-3 | N1 | M0 |
III | T4 | Any N | M0 |
IV | Any T | Any N | M1 |
T | T1 | Tumor limited to pancreas,<2 cm |
---|---|---|
T2 | Tumor limited to pancreas,2-4 cm | |
T3 | >4cm, or invading the duodenum or common bile duct | |
T4 | Tumor invades adjacent structures | |
N | N0 | No regional lymph node metastasis |
N1 | Regional lymph node metastasis | |
M | M0 | No distant metastasis |
M1 | Distant metastasis |
References
- ↑ F. J. Service, M. M. McMahon, P. C. O'Brien & D. J. Ballard (1991). "Functioning insulinoma--incidence, recurrence, and long-term survival of patients: a 60-year study". Mayo Clinic proceedings. 66 (7): 711–719. PMID 01677058. Unknown parameter
|month=
ignored (help) - ↑ Ahmad N, Almutawa AM, Abubacker MZ, Elzeftawy HA, Bawazir OA (2017). "Recurrent insulinoma in a 10-year-old boy with Down's syndrome". Endocrinol Diabetes Metab Case Rep. 2017. doi:10.1530/EDM-16-0155. PMC 5445445. PMID 28567298.
- ↑ Mittendorf EA, Liu YC, McHenry CR (2005). "Giant insulinoma: case report and review of the literature". J Clin Endocrinol Metab. 90 (1): 575–80. doi:10.1210/jc.2004-0825. PMID 15522939.
- ↑ Berger M, Bordi C, Cüppers HJ, Berchtold P, Gries FA, Münterfering H; et al. (1983). "Functional and morphologic characterization of human insulinomas". Diabetes. 32 (10): 921–31. PMID 6311653.
- ↑ 5.0 5.1 5.2 Luo G, Javed A, Strosberg JR, Jin K, Zhang Y, Liu C; et al. (2017). "Modified Staging Classification for Pancreatic Neuroendocrine Tumors on the Basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems". J Clin Oncol. 35 (3): 274–280. doi:10.1200/JCO.2016.67.8193. PMID 27646952.
- ↑ 6.0 6.1 Yang M, Zeng L, Zhang Y, Wang WG, Wang L, Ke NW; et al. (2015). "TNM staging of pancreatic neuroendocrine tumors: an observational analysis and comparison by both AJCC and ENETS systems from 1 single institution". Medicine (Baltimore). 94 (12): e660. doi:10.1097/MD.0000000000000660. PMC 4554009. PMID 25816036.