Insulinoma classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
- There is no established system for the classification of [disease name].
OR
- [Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
OR
- [Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
- [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
OR
- Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
- If the staging system involves specific and characteristic findings and features:
- According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
OR
- The staging of [malignancy name] is based on the [staging system].
OR
- There is no established system for the staging of [malignancy name].
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 recuurence was described as 4 times more common in individuals with MEN 1.[2]
- Insulinoma is also classified into 2 subtypes based on the number of tumor(s):
- Solitary
- Multiple
- 90% of insulinoma are solitary while 10% can be multiple in number
- Previously insulinoma was classified into 2 subtypes based on hormonal level as determined by radioimmunoassay[3]:
- 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
- Insulinoma being a pancreatic neuroendocrine tumor may be classified/staged into several subtypes based on American Joint Cancer Committee(AJCC) 7th edition 2010 [4][5] :
| 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 mesentric 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 [4][5]:
| 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; recent research[4] 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.
- ↑ 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.
- ↑ 4.0 4.1 4.2 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.
- ↑ 5.0 5.1 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.