REPORT OF TWO CASES OF BENIGN INSOLINOMA IN TWO YEARS PERIOD

Insolinoma is a rare, mostly benign pancreatic tumor with 0.5% incidence in general population and is presented in variable size and its different clinical presentations make it to be worthy of making accurate and fast diagnosis. The most clinical manifestations are in the form of psycho-nervous and unconsciousness features due to severe withdrawal of blood glucose. The accurate diagnosis is obtained through the clinical manifestations, especially fasting test and Whipple triad and would be confirmed by mesurement of blood insulin-proinsulin and cortisol levels. For a better determination, other paraclinical investigations are endoscopic or intraoperative ultrasonography, CT scan, MRI, and selective arterial-venous sampling (SAVS) respectively. Moreover, other less accurate but available diagnostic techniques like ultrasonography and daily blood glucose control could be helpful. Treatment is mainly surgery with preoperative localisation of tumor and medical management. Apart from cellular hyperplasia, excision of tumor would be efficient. In this paper, two interesting case of last two years, are presented in which the details are confirmed. Both patients have common characteristics, for instance, age (38-40), suffering period (6-8 years), clinical and diagnostic methods and treatment ways before diagnosis. First patient has cured by surgical enucleation and the second by surgery and pancreaticoduodenal resection (whipple procedure) because of anatomical situation of her tumor. Cure was 100% in two cases and the follow up results were excellent. Regarding the importance and capability of diagnosis of insolinoma by history and the most simple available paraclinical methods; Consequently, the necessity of recognition and being familiar with clinical course of involvement that needs to be followed by relevant referring, is determined. Specially, it has been impressed on “no symptomatic treatment until complete certain diagnosis”.