CLINICOPATHOLOGIC FEATURES AND SURGICAL TREATMENT OF NONFUNCTIONING ISLET CELL TUMORS

摘要

Objective. To investigate clinicopathologic characteristics and surgical results of nonfunctional islet cell tumors. Methods. We performed retrospective analysis of 50 patients with nonfunctional islet cell tumor treated at Peking Union Medical College Hospital from July 1968 to July 1999, and summarized clinical symptoms and signs, primary diagnosis before surgery, surgical treatments, pathologic and immunohisto-logical characteristics. Results. Of the 50 cases examined from July 1968 to July 1999, 12 (24%) were found during physical examinations. The most common symptoms were upper abdominal pain and upper abdominal discomfort, which appeared in 20 cases (40%) and 17 cases (34%) respectively, and the most common sign was abdominal masses (20 cases, 40%). B-ultrasound and CT are the most commonly used means for preoperative examination, with positive rates of 97.8% (46/47) and 100% (25/25) respectively. Operative mortality was 2%. Five-year survival rate of radical surgery of malignant cases was 75%. Immuno-histological examinations showed that tumors rich in multi-peptide linked hormones, neuron-specific eno-lase and chromaffin were in 65% cases (30/46), 90.6% (29/32) and 73.3% (11/15) respectively. The positive rates of insulin, glucagons, somatostatin, pancreatic polypeptide, gastrin and vasoactive intestinal peptide were 68.2% (30/44), 51.2% (22/43), 42.9% (18/42), 40% (16/40), 25% (4/16) and 15.8% (7/38) respectively. Conclusion. Nonfunctional islet cell tumors lack diagnostic specificity. Ultrasound and CT are primary examination methods. Immunohistological analysis indicates different hormones, but lacks the presence of related clinical symptoms. Surgery is an effective treatment for nonfunctional islet cell tumors, and even for those with distal metastasis, immediate surgical removal and treatment can improve prognosis.