Endocrine Tumors of the Pancreas

  • A. Roche
  • A. L. Baert
  • E. Thérasse
  • H. Rigauts
  • G. Marchal
Part of the Medical Radiology book series (MEDRAD)


For almost 20 years, interest in endocrine tumors of the pancreas has been unflagging. In these tumors, the biologist has found a remarkable research model of the physiology of hormonal secretions. The clinician, armed with new methods of biologic diagnosis, has discovered that this pathology may be much more frequent than previously imagined (gastrinoma) and has acquired new therapeutic ammunition (somatostatin). To this model, the pathologist has added theories that go far beyond purely pancreatic and even digestive pathology. The radiologist, who has always encountered difficulties in exploring the pancreas, has forged new arms (intraoperative and endoscopic ultrasonography, functional methods of radioendocrinologic localization) specifically adapted to the detection problems presented by these tumors.


Superior Mesenteric Vein Endocrine Tumor Splenic Vein Iodinate Contrast Medium Islet Cell Tumor 
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  1. Ahlström H, Magnusson A, Grama D, Eriksson B, Öberg K, Lörelius LE (1990) Preoperative localization of endocrine pancreatic tumors by intra-arterial dynamic CT. Acta Radiol 31:171–174PubMedCrossRefGoogle Scholar
  2. Boijsen E, Samuelsson L (1970) Angiographic diagnosis of tumors arising from the pancreatic islets. Acta Radiol (Diagn) 10:161–170Google Scholar
  3. Boissel P, Proye C (1985) Les tumeurs endocrines du pancréas. Masson, ParisGoogle Scholar
  4. Bok E, Cho KJ, Williams D, Brady T, Weiss CA, Forrest M (1984) Venous involvement in islet cell tumors of the pancreas. AJR 142:319–322PubMedGoogle Scholar
  5. Bonfils S (1983) Les difficultés de la localisation topographique du gastrinome. Gastroenterol Clin Biol 7:639PubMedGoogle Scholar
  6. Bonfils S, Landor J, Mignon M, Hervoir P (1981) Results of surgical management in 92 consecutive patients with Zollinger-Ellison syndrome. Ann Surg 194:692–697PubMedCrossRefGoogle Scholar
  7. Breathnach ES, Han SY, Rahatzad MT, Stanley RJ (1985) CT evaluation of glucagonomas. J Comput Assist Tomogr 9:25–29CrossRefGoogle Scholar
  8. Brunt L, Veldhuis J, Dilley W, et al. (1986) Stimulation of insulin secretion by a rapid intravenous calcium infusion in patients with B-cell neoplasms of the pancreas. J Clin Endrocrinol Metab 62:210–216CrossRefGoogle Scholar
  9. Burcharth F, Stage J, Stadil F, Jensen L, Fischermann K (1979) Localization of gastrinomas by transhepatic portal catheterization and gastrin assay. Gastroenterology 77:444–450PubMedGoogle Scholar
  10. Calas F, Bouchet Y, Martin R, Couppie G (1956) Les veines du pancréas. 43° Réunion de l’Association des anatomistes, LisbonGoogle Scholar
  11. Cherner J, Doppman J, Norton J, et al. (1986) Selective venous sampling for gastrin to localize gastrinomas: a prospective assessment. Ann Intern Med 105:841–847PubMedGoogle Scholar
  12. Clouse M, Costello P, Legg M, Soeldner S, Cady B (1977) Subselective angiography in localizing insulinomas of the pancreas. AJR 128:741–746PubMedGoogle Scholar
  13. Collen M, Doppman J, Krudy A, et al. (1984) Assessment of the ability of angiography to localize gastrinoma in patients with Zollinger-Ellison syndrome. Gastroenterology 86:1051Google Scholar
  14. Cromack DT, Norton JA, Sigel B, Shawker TH, Doppman JL, Maton PN, Jensen RT (1987) The use of high-resolution intraoperative ultrasound to localize gastrinomas: an initial report of a prospective study. World J Surg 11:648–653PubMedCrossRefGoogle Scholar
  15. Daggett P, Kurtz A, Morris D, et al. (1981) Is pre-operative localisation of insulinomas necessary? Lancet 1:483–486PubMedCrossRefGoogle Scholar
  16. Deveney C, Deveney K, Way L (1978) The ZollingerEllison syndrome 23 years later. Ann Surg 188:384–391PubMedCrossRefGoogle Scholar
  17. Doppman J, Brennan M, Dunnick N, Kahn C, Gorden P (1981a) The role of pancreatic venous sampling in the localization of occult insulinomas. Radiology 138:557–562PubMedGoogle Scholar
  18. Doppman J, Popovsky M, Girton M (1981b) The use of iodinated contrast agents to ablate organs: experimental study and histopathology. Radiology 138:333–340PubMedGoogle Scholar
  19. Doppman J, Miller D, Chang R, et al. (1990) Gastrinomas: localization by means of selective intraarterial injection of secretin. Radiology 174:25–29PubMedGoogle Scholar
  20. Doppman J, Miller D, Chang R, Shawker T, Gorden P, Norton J (1991) Insulinoma: localization with selective intraarterial injection of calcium. Radiology 178:237–241PubMedGoogle Scholar
  21. Doyon D, Harry G, Roche A (1979) Techniques de la portographie. In: Ecoiffier J, Tessier JP, Roche A, Fischgold H (eds) Précis de techniques spécialisées en radiodiagnostic. Masson, Paris, pp 518–520Google Scholar
  22. Eelkema EA, Stephens DH, Ward EM, Sheedy PF (1984) CT features of non-functioning islet cell carcinoma. AJR 143:943–948PubMedGoogle Scholar
  23. Fenichel P, Rozo P, Hammou J, Harter M (1983) Double récidive d’un adénome bêtalangerhansien bénin. Nouv Presse Med 12:1018–1019Google Scholar
  24. Fink IJ, Krudy AG, Shawker, et al. (1985) Demonstration of angiographically hypovascular insulinoma with intraarterial dynamic CT. AJR 144:555–557PubMedGoogle Scholar
  25. Frucht H, Doppman JL, Norton JA, et al. (1989) Gastrinomas: comparison of MR imaging with CT, angiography and US. Radiology 171:713–717PubMedGoogle Scholar
  26. Fugazzola C, Procacci C, Andreis IAB, et al. (1990) The contribution of ultrasonography and computed tomography in the diagnosis of nonfunctioning islet cell tumors of the pancreas. Gastrointest Radiol 15:139–144PubMedCrossRefGoogle Scholar
  27. Fujii K, Yamagata S, Sasaki R, Ohneda A, Shoji T, Suzuki J (1974) Arteriography in insulinoma. AJR 120:634–647Google Scholar
  28. Fulton R, Sheedy P, McIlrath D, Ferris D (1975) Preoperative angiographic localization of insulin-producing tumors of the pancreas. AJR 123:367–377Google Scholar
  29. Galiber AK, Reading CC, Charboneau JW, et al. (1988) Localisation of pancreatic insulinoma: comparison of pre- and intra-operative ultrasound with CT and angiography. Radiology 166:405–408PubMedGoogle Scholar
  30. Gianello P, Gigot JF, Berthet F, et al. (1988) Pre- and intra-operative localization of insulinomas: report of 22 observations. World J Surg 12:389–397PubMedCrossRefGoogle Scholar
  31. Glover JR, Shorvon PJ, Lees WR (1992) Endoscopic ultrasound for localisation of islet cell tumours. Gut 33:108–110PubMedCrossRefGoogle Scholar
  32. Gorman B, Charboneau JW, James EM, et al. (1986) Benign pancreatic insulinoma: pre-operative and intraoperative sonographic localization. AJR 147:929–934PubMedGoogle Scholar
  33. Grant CS, van Heerden J, Charboneau JW, James EM, Reading CC (1988) Insulinoma. The value of intraoperative ultrasonography. Arch Surg 123:843–848PubMedCrossRefGoogle Scholar
  34. Guillausseau P, Guillausseau C, Villet R, Kaloustian E, Valeur P, Hautefeuille P (1982) Les glucagonomes. Aspects cliniques, biologiques, anatomo-pathologiques et thérapeutiques. Revue générale de 130 cas. Gastroenterol Clin Biol 6:1029–1041PubMedGoogle Scholar
  35. Gunther RW, Klose KJ, Ruckert K (1983) Islet cell tumours: detection of small lesions with CT and US. Radiology 148:485–489PubMedGoogle Scholar
  36. Hautefeuille P, Valeur P, Gallian A, Roche A (1979) Surgical cure of malignant microscopic gastrinoma. Lancet 1:122Google Scholar
  37. Hoevels J, Lunderquist A, Tylen U (1978) Percutaneous transhepatic portography. Acta Radiol (Diagn) 19: 643–655Google Scholar
  38. Houlbert D, Roche A, Dorf G, Gardies A, Roche D, Segrestaa J (1984) La localisation préopératoire des insulinomes est-elle nécessaire? Ann Méd Interne (Paris) 13:16–20Google Scholar
  39. Huguet J, Clement J, Jean P, Clerissi J, Burelle H (1978) Les tumeurs endocrines du pancréas. J Radiol Electrol 59:249–260PubMedGoogle Scholar
  40. Imamura M, Takahashi K, Isobe Y, Hattori Y, Satomura K, Tobe T (1989) Curative resection of multiple gastrinomas aided by selective arterial injection test and intra-operative secretin test. Ann Surg 210:710–718PubMedCrossRefGoogle Scholar
  41. Imhof H, Frank P (1977) Pancreatic calcifications in malignant islet cell tumours. Radiology 122:333–338PubMedGoogle Scholar
  42. Ingemansson S, Lunderquist A, Lundquist I, Lovdahl R, Tibblin S (1975) Portal and pancreatic vein catheterization with radio-immunologic determination of insulin. Surg Gynecol Obstet 141:705–711PubMedGoogle Scholar
  43. Ingemansson S, Lunderquist A, Holst J (1976) Selective catheterization of the pancreatic veins for radioimmuno-assay in glucagon-secreting carcinoma of the pancreas. Radiology 119:555–556PubMedGoogle Scholar
  44. Ingemansson S, Kuhl C, Larsson L, Lunderquist A, Nobin A (1977) Islet cell hyperplasia localized by pancreatic vein catheterization and insulin radio-immuno-assay. Am J Surg 133:643–645PubMedCrossRefGoogle Scholar
  45. Kallio H, Suoranta H (1979) Localization of occult insulin secreting tumors of the pancreas. Ann Surg 189:49–52PubMedCrossRefGoogle Scholar
  46. Keller F, Niles N, Rosch J, Dotter C, Stenzel-Poore M (1980) Retrograde pancreatic venography: autopsy study. Radiology 135:285–293PubMedGoogle Scholar
  47. Kimmey MB, Martin RW, Silverstein FE (1992) First clinical experience with ultrasound probes. Clinical application of linear ultrasound probes. Endoscopy 24 (Suppl l):364–369PubMedCrossRefGoogle Scholar
  48. Krudy AG, Doppman LJ, Jansen RT (1984) Localisation of islet-cell tumours by dynamic CT: comparison with plani CT, arteriography, sonography and venous sampling. AJR 143:585–591PubMedGoogle Scholar
  49. Larsson L, Holst J, Kühl C, et al. (1977) Pancreatic somatostatinoma: clinical features and physiological implications. Lancet 1:666–668PubMedCrossRefGoogle Scholar
  50. Liessi G, Pasquali C, D’Andrea A, Scandellari C, Pedrazzola S (1992) MRI in insulinomas: preliminary findings. Eur J Radiol 14:46–51PubMedCrossRefGoogle Scholar
  51. Lightdale CJ, Botet JF, Woodruff JM, Brennan MF (1991) Localization of endocrine tumors of the pancreas with endoscopic ultrasonography. Cancer 68:1815–1820PubMedCrossRefGoogle Scholar
  52. Lunderquist A, Eriksson M, Ingemansson S, Larsson L, Reichardt W (1978) Selective pancreatic vein cathe terization for hormone assay in endocrine tumors of the pancreas. Cardiovasc Radiol 1:117–124PubMedCrossRefGoogle Scholar
  53. Martin E, Bedossa P, Potet F (1987) Tumeurs et hyperplasies endocrines du pancréas. Caractères anatomopathologiques. In: Bonfils S, Mignon M (eds) Tumeurs endocrines du pancréas. Doin, Paris, pp 17–35Google Scholar
  54. Maton P, Miller D, Doppman J, et al. (1987) Role of selective angiography in the management of patients with Zollinger-Ellison syndrome. Gastroenterology 92:913–918PubMedGoogle Scholar
  55. McCarthy D (1980) The place of surgery in the Zollinger-Ellison syndrome. N Engl J Med 302:1344–1347PubMedCrossRefGoogle Scholar
  56. Mignon M, Rigaud D, Ruszniewski P, Vallot T, Rene E, Bonfils S (1987) Le syndrome de Zollinger-Ellison. Stratégie diagnostique et thérapeutique actuelle. In: Bonfils S, Mignon M (eds) Tumeurs endocrines du pancréas. oin, Paris, pp 37–66Google Scholar
  57. Millan V, Urosa C, Molitch M, Miller H, Jackson I (1979) Localization of occult insulinoma by super-selective pancreatic venous sampling for insulin assay through percutaneous transhepatic catheterization. Diabetes 28:249–251PubMedGoogle Scholar
  58. Mills S, Doppman J, Dunnick N, McCarthy D (1979) Evaluation of angiography in Zollinger-Ellison syndrome. Radiology 131:317–320PubMedGoogle Scholar
  59. Mitchell D, Cruvella M, Eschelman D, Miettinen M, Vernick J (1992) MRI of pancreatic gastrinomas. J Comp Assist Tomogr 16:583–585CrossRefGoogle Scholar
  60. Mitty H, Efremidis S, Wertkin M, Dreiling D, Rayfield E (1979) Localization in insulinomas by radio-immunoassay of blood obtained by the transportai route. J Clin Endocrinol Metab 48:1035–1037PubMedCrossRefGoogle Scholar
  61. Moreaux J (1981) Traitement chirurgical du syndrome de Zollinger-Ellison. Ses résultats chez 34 malades et son orientation actuelle. Chirurgie 107:557–565PubMedGoogle Scholar
  62. Moreaux J, Olivier A (1987) Traitement chirurgical des tumeurs endocrines du pancréas. In: Bonfils S, Mignon M (eds) Tumeurs endocrines du pancréas. Doin, Paris, pp 201–215Google Scholar
  63. Norton JA, Doppman JL, Collen MJ, Harmon JW, Maton PN, Gardener JD, Jensen RT (1986) Prospective study of gastrinoma localization and resection in patients with Zollinger-Ellison syndrome. Ann Surg 204:468–479PubMedCrossRefGoogle Scholar
  64. Norton JA, Cromack DT, Shawker TH, et al. (1988) Intra-operative ultrasonographic localization of islet cell tumors. Ann Surg 207:160–168PubMedCrossRefGoogle Scholar
  65. Päivänsalo M, Mäkäräinen H, Siniluoto T, Stahlberg M, Jalovaara P (1989) Ultrasound compared with computed tomography and pancreatic arteriography in the detection of endocrine tumours of the pancreas. Eur J Radiol 9:173–178PubMedGoogle Scholar
  66. Palazzo L (1991) Echo-endoscopie du tube digestif. Rev Prat (Paris) 41:225–231Google Scholar
  67. Palazzo L, Roseau G, Salmeron M (1992) Endoscopic ultrasonography in the preoperative localization of pancreatic endocrine tumors. Endoscopy 24 (Suppl 1):350–353PubMedCrossRefGoogle Scholar
  68. Passariello R, Rossi P, Simonetti G, Di Paolo A (1978) Cathétérisme portal transhépatique pour la localisation des tumeurs sécrétantes du pancréas. Ann Radiol 21: 485–490PubMedGoogle Scholar
  69. Passaro E (1979) Localization of pancreatic endocrine tumors by selective portal vein catheterization and radio-immuno-assay. Gastroenterology 77:806–807PubMedGoogle Scholar
  70. Pistolesi C, Frasson F, Fugazzola C, et al. (1977) Angiographic diagnosis of endocrine tumors of the pancreas. Radiol Clin 46:401–421Google Scholar
  71. Rambaud JC, Jian R (1987) Choléra pancréatique (syndrome de Verner-Morrison). In: Bonfils S, Mignon M (eds) Tumeurs endocrines du pancréas. Doin, Paris, pp 101–114Google Scholar
  72. Reichardt W, Cameron R (1980) Anatomy of the pancreatic veins. A post mortem and clinical phlebographic investigation. Acta Radiol (Diagn) 21:33–41Google Scholar
  73. Reichardt W, Ingemansson S (1980) Selective vein catheterization for hormone assay in endocrine tumours of the pancreas: technique and results. Acta Radiol (Diagn) 21:177–187Google Scholar
  74. Ribet A, Pradayrol L, Bommelaer G, Cloarec D (1987) Les somatostatinomes. In: Bonfils S, Mignon M (eds) Tumeurs endocrines du pancréas. Doin, Paris, pp 137–145Google Scholar
  75. Roche A, Raisonnier A, Gillon-Savouret M (1982) Pancreatic venous sampling and arteriography in localizing insulinomas and gastrinomas: procedure and results in 55 cases. Radiology 145:621–627PubMedGoogle Scholar
  76. Roche A, Capeau J, Halimi P (1983) Méthodes radiologiques de localisation des tumeurs endocrines du pancréas. Gastroenterol Clin Biol 7:49–58PubMedGoogle Scholar
  77. Rosch T, Lorenz R, Braig C, Feuerbach S, Siewert JR, Schusdziarra V, Classen M (1991) Endoscopic ultrasound in pancreatic tumor diagnosis. Gastrointest Endosc 37:347–352PubMedCrossRefGoogle Scholar
  78. Rosch T, Lightdale CJ, Botet JF, et al. (1992a) Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med 326:1721–1726PubMedCrossRefGoogle Scholar
  79. Rosch T, Lorenz R, Braig C, Classen M (1992b) Endoscopic ultrasonography in diagnosis and staging of pancreatic and biliary tumors. Endoscopy 24 (Suppl 1): 304–308PubMedCrossRefGoogle Scholar
  80. Rossi P, Baert AL, Marchai G, Tipaldi L, Wilms G, Pavone P (1982) Multiple bolus technique vs. single bolus or infusion of contrast medium to obtain prolonged contrast enhancement of pancreas. Radiology 144:929–931PubMedGoogle Scholar
  81. Rossi P, Baert AL, Passariello R (1985) CT of functioning tumours of the pancreas. AJR 144:57–63PubMedGoogle Scholar
  82. Rossi P, Allison DJ, Bezzi M, et al. (1989) Endocrine tumors of the pancreas. Radiol Clin North Am 27: 127–161Google Scholar
  83. Stacpoole P (1981) The glucagonoma syndrome: clinical features, diagnosis, and treatment. Endocr Rev 2: 347–361PubMedCrossRefGoogle Scholar
  84. Stefanini P, Carboni M, Patrassi N (1974) Beta-islet tumors of the pancreas: results of a study on 1067 cases. Surgery 75:597–609PubMedGoogle Scholar
  85. Sugimura H, Tamura S, Kodama T, Kakitsubata Y, Asada K, Watanabe K (1991) Metastatic pancreas cancer from the thyroid; clinical imaging mimicking nonfunctioning islet cell tumor. Radiat Med 9:167–169PubMedGoogle Scholar
  86. Tjon A, Tham RTO, Falke THM, Jansen JBMJ, Lamers CBHW (1989a) CT and MR imaging of advanced Zollinger-Ellison syndrome. J Comput Assist Tomogr 13:821–828CrossRefGoogle Scholar
  87. Tjon A, Tham RTO, Jansen JBMJ, et al. (1989b) MR, CT, and ultrasound findings of metastatic vipoma in pancreas. J Comput Assist Tomogr 13:142–144CrossRefGoogle Scholar
  88. Turner R, Morris P, Lee E, Harris E (1978) Localisation of insulinomas. Lancet 1:515–518PubMedCrossRefGoogle Scholar
  89. van Heerden J, Edis A, Service F (1979) The surgical aspects of insulinomas. Ann Surg 189:677–682PubMedCrossRefGoogle Scholar
  90. Verner J, Morrison A (1974) Endocrine pancreatic islet disease with diarrhea. Report of a case due to diffuse hyperplasia of nonbeta islet tissue with a review of 54 additional cases. Arch Intern Med 133:492–500PubMedCrossRefGoogle Scholar
  91. Vilman P, Jacobsen GK, Henriksen FW, Haneke S (1992) Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc 38:172–173CrossRefGoogle Scholar
  92. Vinik A, Thompson N (1986) Controversies in the management of Zollinger-Ellison syndrome. Ann Intern Med 105:956–959PubMedGoogle Scholar
  93. Wank SA, Doppman JL, Miller DL (1987) Prospective study of the ability of computed axial tomography to localize gastrinomas in patients with Zollinger-Ellison syndrome. Radiology 165:588Google Scholar
  94. Wilms G, Baert AL, Dardenne AN, et al. (1990) Percutaneous transhepatic venous sampling of the pancreas in localizing insulinomas. J Belge Radiol 73: 453–457PubMedGoogle Scholar
  95. Xianju Z, Yu Z, Weiran W, Tonghua L (1980) Insulinoma: diagnostic and therapeutic experiences in 60 cases. Clin Med J 93:149–158Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • A. Roche
    • 1
  • A. L. Baert
    • 2
  • E. Thérasse
    • 1
  • H. Rigauts
    • 2
  • G. Marchal
    • 2
  1. 1.Service de Radiodiagnostic, Unité de Radiologie Interventionnelle et VasculaireInstitut Gustave RoussyVillejuif CédexFrance
  2. 2.Department of RadiologyUniversity Hospital K. U. L.LeuvenBelgium

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