Comparison of benign and malignant insulinoma

Alaa Sada, Thomas Szabo Yamashita, Amy E. Glasgow, Elizabeth B. Habermann, Geoffrey B. Thompson, Melanie L. Lyden, Benzon M. Dy, Thorvardur R. Halfdanarson, Adrian Vella, Travis J. McKenzie

Research output: Contribution to journalArticlepeer-review


Background: How malignant insulinomas present relative to benign insulinomas is unknown. Methods: A single-institution retrospective study identified patients with insulinoma. Malignancy was defined by distant metastases, positive lymph node(s), T stage of 4, direct invasion into surrounding peripancreatic tissue, or presence of lymphovascular invasion. Wilcoxon Rank Sum tests and Kaplan-Meier analysis were used. Results: A total of 311 patients were identified: 51 malignant and 260 benign. Patients with malignant insulinoma presented with higher levels of insulin, proinsulin, and c-peptide. Malignant lesions were larger: 4.2 ± 3.2 vs 1.8 ± 0.8 cm in benign lesions, p < 0.01. Overall survival at 5 years was 66.8% vs 95.4% for malignant and benign insulinoma respectively, p < 0.01. Conclusions: Larger size of insulinoma and increased serum β-cell polypeptide concentrations were associated with malignancy. Malignant insulinoma has poorer survival. Further work-up to rule out malignancy may be indicated for larger pancreatic lesions and for patients with higher pre-operative insulin and pro-insulin.

Original languageEnglish (US)
Pages (from-to)437-447
Number of pages11
JournalAmerican journal of surgery
Issue number2
StatePublished - Feb 2021


  • Insulinoma
  • Pancreas
  • Pancreatic neuroendocrine tumor

ASJC Scopus subject areas

  • Surgery


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