Skip to Main Content

+

  • • No overt clinical syndrome

    • Pancreatic mass on CT scan

    • Elevated serum levels of chromogranin A, pancreatic polypeptide, and hCG

    • Overall worse prognosis than other pancreatic islet cell tumors

++

Epidemiology

+

  • • Account for 30-50% of pancreatic endocrine tumors

    • Elevated serum levels of chromogranin A, pancreatic polypeptide, and hCG are common, without any accompanying clinical syndrome

    • Most nonfunctioning tumors are large, malignant, and located in the head of the pancreas

    • Metastases are present at the time of diagnosis in 80% of patients

++

Symptoms and Signs

+

  • • Abdominal and back pain

    • Weight loss

    • Jaundice

    • Nausea and vomiting

    • Palpable abdominal mass

++

Laboratory Findings

+

  • • Elevated serum bilirubin

    • Elevated serum chromogranin A

    • Elevated serum pancreatic polypeptide

    • Elevated serum hCG

++

Imaging Findings

+

  • CT scan

    • -Shows a pancreatic mass, which is typically hypervascular and/or partially cystic with areas of calcification

      -Also useful for detection of metastases

    Octreotide scintigraphy may be useful

+

  • • The histologic pattern on biopsy specimens is diagnostic of islet cell tumor, but whether or not the lesion is malignant rests on evidence of invasiveness or metastases, not the histology

    • Immunohistochemical staining of the tissue is positive for chromogranin and neuron-specific enolase (markers of APUD tumors)

++

Rule Out

+

  • • Functional islet cell tumors

    • Adenocarcinoma of the head of the pancreas

    • Chronic pancreatitis

+

  • • CT scan or somatostatin receptor scintigraphy

    • Serum levels of chromogranin A, pancreatic polypeptide, and hCG

++

When to Admit

+

  • • Severe symptoms

++

Surgery

+

  • • Resection of primary tumor (head, pancreaticoduodenectomy; body and tail, distal pancreatectomy) and debulking of metastases

++

Indications

+

  • • All cases of completely respectable disease

++

Medications

+

  • • Streptozocin and doxorubicin for unresectable tumor

++

Complications

+

  • • Biliary obstruction

    • Duodenal obstruction

++

Prognosis

+

  • • 5-year disease-free survival rate is 15%

++

References

Bartsch DK et al. Management of nonfunctioning islet cell carcinomas. World J Surg. 2000;24:1418.  [PubMed: 11038216]
Somogyi L, Mishra G. Diagnosis and staging of islet cell tumors of the pancreas. Curr Gastroenterol Rep. 2000;2:159.  [PubMed: 10981018]

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.