Pathology

Insulinomas tend to be small tumors equally distributed throughout the pancreas (see Figure 13-5 for distribution data in our patients). In our 50 patients

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Figure 13-5. Distribution of insulinomas among the patients at our institution. Adapted from Boukhman MB et al.33

Figure 13-5. Distribution of insulinomas among the patients at our institution. Adapted from Boukhman MB et al.33

with solitary tumors, the average size of insulinomas was 1.8 cm in diameter. Thirteen patients had tumors < 1 cm in diameter. The size distribution of the insulinomas is shown in Figure 13-6. Approximately 1% of tumors are ectopic.

Approximately 10% of insulinomas are multiple, 10% are malignant, and 10% occur in patients with MEN type I. These patients usually (approximately 85%) have multiple insulinomas. The presence of multiple insulinomas should alert clinicians to screen for the presence of MEN type I. Early diagnosis of MEN type I is important because of the different surgical management for patients with MEN type I and insulinomas. MEN type I can also be diagnosed preoperatively based on the family history of this condition and on the presence of other endocrine tumors in these patients, especially hyperparathyroidism. In our series of 66 patients, 7 MEN type I patients had hyperparathyroidism, 5 pituitary adenomas, 5 gastrinomas, 1 malignant carcinoid, 1 thyromegaly, 2 papillary carcinomas of the thyroid, 1 hyperal-dosteronism, and 1 hypotestosteronism. Among our 8 patients with malignant insulinoma, metas-

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