The dilemma of the diagnosis of insulinomas and its differentiation from other small pancreatic focal lesions!
A 25 years old female with frequent bouts of severe hypoglycemia with upper normal insulin and C-peptide levels.
- CT revealed a hypervasular small head mass suggestive of NET.
- EUS in another center revealed no masses.
- Dynamic MRI was negative for masses.
- she was referred for EUS, this small (6 x 6 mm) focal lesion was seen in the pancreatic head (video).
I recommended Gallium Dotatate PET scan that showed no active lesions!
What is the next step?
We have the following options :
- Selective arterial calcium stimulation test.
- EUS contrast (Sonoview).
- EUS biopsy.
- EUS RFA.
- Surgery.
So what do you think??
