Question

A lady presented with recurrent attacks of giddiness and abdominal pain for three months. Endoscopy was normal. Her fasting blood glucose was 40 mg% and insulin levels were elevated. CT abdomen showed a well defined 8 mm enhancing lesion in the head of the pancreas, with no other abnormal findings. What should be the treatment plan for this patient?

• A. Whipple's operation
• B. Enucleation
• C. Enucleation with radiotherapy
• D. Administration of streptozotocin

Hint:

Small benign insulinoma wants the most tissue-sparing operation.

Answer 1

The Correct Option is B

Step 1: Fasting hypoglycaemia (glucose 40 mg%) with inappropriately high insulin and a small enhancing pancreatic lesion is the picture of an insulinoma. The symptoms fit Whipple's triad: symptoms of hypoglycaemia, low measured glucose, and relief with glucose.
Step 2: Insulinomas are usually small (often under 2 cm), solitary and benign (about 90%). This one is only 8 mm and well defined, so it behaves as a typical benign lesion.
Step 3: For a small, benign, well-localised insulinoma, the treatment of choice is simple surgical enucleation. This removes the tumour while preserving maximal pancreatic tissue and exocrine and endocrine function.
Step 4: Whipple's operation (option A) is an extensive pancreaticoduodenectomy reserved for large, deep, or malignant pancreatic head tumours; it is excessive for an 8 mm benign nodule.
Step 5: Radiotherapy (option C) has no role for a benign, resectable insulinoma. Streptozotocin (option D) is chemotherapy used for unresectable or metastatic malignant islet cell tumours, not for a small benign curable lesion.
Conclusion: The correct answer is B. Enucleation.