INSULINOMA AND METABOLIC URGENCY CASE REPORT

Insulinoma is a rare neuroendocrine tumor, occurring almost exclusively in the pancreas. Most often unique and benign in 90% of cases. Usually sporadic, 10% of lesions become part of type 1 multiple endocrine neoplasia. The main manifestation of insulinoma is hypoglycemia, which is a life-threatening metabolic emergency. The hypoglycemia occurring in this context are particularly serious and frequent with sometimes harmful cerebral consequences. Topographic diagnosis remains difficult due to the small size of the lesions justifying the importance of the preoperative imaging required for the location of the tumor. Enucleation is the surgical indication of choice in the presence of a sporadic insulinoma that is presumably benign. Pathological and immunohistochemical examination confirms the diagnosis of neuroendocrine tumor. Our observation is particular by the circumstances of discovery of the insulinoma, the severe nature of the symptoms.

Long-Term Oncologic Outcomes After Laparoscopic and Robotic Tumor Enucleation for Renal Cell Carcinoma

ObjectivesTumor enucleation (TE) optimizes parenchymal preservation with promising short-term oncologic outcomes compared with standard partial nephrectomy (SPN). However, researches/literatures about long-term oncologic outcomes for TE after minimally invasive surgery are scarce. We aim to analyze long-term oncologic outcomes after laparoscopic and robotic tumor enucleation for renal cell carcinoma (RCC).Patients and MethodsWe retrospectively analyzed 146 patients who underwent TE with either laparoscopic or robotic approach for localized RCC in our center. Local recurrence, cancer specific survival (CSS), recurrence free survival (RFS), and overall survival (OS) were the main outcomes. Survival curves were generated using a Kaplan-Meier method. Perioperative outcomes and pathological outcomes were also analyzed.ResultsOverall, 98 male and 48 female patients were eligible for the study. The median tumor size was 3.4 cm with a median R.E.N.A.L. score of seven. Warm ischemia was used in 143 patients with a median ischemia time of 20 min and three patients had zero ischemia. Five patients (3.4%) had major complications (> Clavien IIIa) and only two were related to urinary system. The median global glomerular filtration rate (GFR) preserved after surgery was 93%. Pseudocapsule invasion was reported in 50 tumors (34%) and positive surgical margins were found in 3/146 (2.1%) tumors. At a median follow-up of 66 months, local recurrence happened in two patients (1.4%), and systemic recurrence happened in six patients (4.2%). The 5-year CSS, RFS, OS were 95.7, 89.6, and 91.9%, and the 10-year CSS, RFS, OS were 93.8, 89.6, and 90.0%, respectively.ConclusionThis study indicates that tumor enucleation with laparoscopic or robotic approach in experienced hands for the treatment of RCC appears oncologically safe with a median follow-up of more than 5 years. Prospective studies with more patients and longer follow-up will be required to further evaluate oncologic safety after TE.

Testis-Preserving Tumor Enucleation Is Applicable in Children with Immature Testicular Teratoma

<b><i>Introduction:</i></b> This study investigated the biological characteristics of immature testicular teratoma in children and explored the feasibility of testis-preserving tumor enucleation. <b><i>Methods:</i></b> We retrospectively reviewed the cases of 23 children who received a pathologic diagnosis of immature testicular teratoma between January 2005 and December 2018. Ages ranged from 16 days to 13 months (mean: 6 months and 5 days). Painless testicular enlargement was the main clinical manifestation, and the course of disease ranged from 20 days to 4 months (mean: 1.4 months). The tumor volume ranged from 1.5 × 1.2 × 0.5 to 6 × 5 × 4.5 cm. Elevated levels of alpha-fetoprotein were measured in 21 patients. Preoperative ultrasound examination showed a cystic/solid mass with calcification. <b><i>Results:</i></b> Excision of the affected testis was done in 10 patients and testis-preserving tumor excision in 13 patients. Postoperative chemotherapy was not employed. Nineteen patients were followed up for 1–10 years, and all showed disease-free survival without recurrence or metastasis. <b><i>Conclusion:</i></b> Immature testicular teratoma is found predominantly in children aged &#x3c;1 year, and its biological characteristics are different from those in adults. Immature testicular teratoma is largely benign in children and can be managed by testis-preserving tumor enucleation, as for other benign tumors (such as mature teratoma). Postoperative monitoring and follow-up are necessary.