# Pancreatic Tumors — GCMD Library living collection

Also covered as: pancreatoblastoma · pancreatic ductal adenocarcinoma · insulinoma · gastrinoma · multiple endocrine neoplasia type 1 · hypoglycemia

Experts: Dr. Rod Gerardo, Dr. Jamie Nathan, Dr. David Skarda

Updated: n/a · 2 episodes · 81 cited statements

## Episodes
### Case-Based Learning
- [Pancreatic Masses](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439) — podcast · 37:28 · [machine version](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439.md)

### In-Depth Reviews
- [Pancreatic Tumors. Presented by David Skarda, MD 04.10.23 Video](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583) — video · 50:30 · [machine version](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=0) Introduction and differential diagnosis of pancreatic masses (Ep 1)
- [5:14](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=314) Common pediatric pancreatic tumors: pancreatoblastoma, solid pseudopapillary neoplasms, and neuroendocrine tumors (Ep 1)
- [10:47](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=647) Clinical presentation and diagnostic workup (Ep 1)
- [15:49](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=949) Role of endoscopic ultrasound and case progression (Ep 1)
- [19:39](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1179) Case resolution and surgical decision-making (Ep 1)
- [22:05](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1325) Surgical approaches and parenchyma preservation (Ep 1)
- [26:41](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1601) Autoimmune pancreatitis: types, diagnosis, and management (Ep 1)
- [35:03](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=2103) Concluding remarks (Ep 1)
- [1:11](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=71) Introduction and Benign Pancreatic Lesions (Ep 2)
- [5:30](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=330) Solid Pseudopapillary Tumors and Management Discussion (Ep 2)
- [24:03](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1443) Malignant Pancreatic Tumors (Ep 2)
- [36:12](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2172) Endocrine Pancreatic Tumors: Insulinomas and Gastrinomas (Ep 2)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Elevated lipase and elevated bilirubin suggest obstruction in the pancreatic head, which can be caused by neoplasms or more commonly in pediatrics by non-neoplastic findings such as autoimmune pancreatitis or complications of pancreatitis." — Jamie Nathan (clinical) [Ep 1 · 1:21](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=81)
- "Pancreatoblastoma is the most common malignant pancreatic tumor in children, typically presenting in patients less than 10 years of age." — Jamie Nathan (epidemiological) [Ep 1 · 5:14](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=314)
- "In pancreatoblastoma, alpha-fetoprotein is elevated in up to 80% of cases." — Jamie Nathan (clinical) [Ep 1 · 5:40](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=340)
- "Up to 45-50% of pancreatoblastoma cases present with metastases." — Jamie Nathan (epidemiological) [Ep 1 · 5:50](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=350)
- "Pancreatoblastomas respond well to chemotherapy with a cisplatin and doxorubicin-based regimen." — Jamie Nathan (clinical) [Ep 1 · 6:00](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=360)
- "The number one prognostic factor for pancreatoblastoma is complete surgical excision, whether at initial presentation or following neoadjuvant chemotherapy." — Jamie Nathan (clinical) [Ep 1 · 6:10](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=370)
- "Solid pseudopapillary neoplasms are more common in young female patients, typically in their second or third decade of life." — Jamie Nathan (epidemiological) [Ep 1 · 6:25](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=385)
- "Solid pseudopapillary tumors are indolent and slow-growing, often presenting with very large masses in the body and tail of the pancreas." — Jamie Nathan (clinical) [Ep 1 · 6:40](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=400)
- "Enucleation or simple biopsy of solid pseudopapillary neoplasms should be avoided due to high recurrence rates; complete surgical resection is required." — Jamie Nathan (clinical) [Ep 1 · 6:55](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=415)
- "Solid pseudopapillary neoplasms have a recurrence rate of up to 10% but excellent long-term survival with 95% 10-year survival." — Jamie Nathan (epidemiological) [Ep 1 · 7:04](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=424)
- "Neuroendocrine tumors make up about 1-2% of all pancreatic tumors and can be either benign adenomas or malignant carcinomas." — Jamie Nathan (epidemiological) [Ep 1 · 9:30](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=570)
- "Neuroendocrine tumors tend to present in children over 10 years of age, though they are more common in middle-aged patients." — Jamie Nathan (epidemiological) [Ep 1 · 9:45](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=585)
- "In 10% of patients, neuroendocrine tumors may present in the setting of multiple endocrine neoplasia type 1, von Hippel-Lindau, or tuberous sclerosis." — Jamie Nathan (clinical) [Ep 1 · 9:55](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=595)
- "Insulinoma is the most common neuroendocrine tumor, accounting for almost 50% of pancreatic neuroendocrine tumors, followed by gastrinomas at 30%." — Jamie Nathan (epidemiological) [Ep 1 · 10:10](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=610)
- "Insulinomas are typically benign; 6% can be malignant. 90% are solitary, 10% are associated with MEN1." — Jamie Nathan (epidemiological) [Ep 1 · 10:25](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=625)
- "Insulinomas present with Whipple's triad: symptoms of hypoglycemia, low fasting blood glucose, and symptom resolution with glucose administration." — Jamie Nathan (clinical) [Ep 1 · 10:40](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=640)
- "On imaging, a solid lesion in the pancreas is more worrisome than a cystic lesion when found incidentally." — Jamie Nathan (clinical) [Ep 1 · 12:00](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=720)
- "Ultrasound is low cost and easily accessible but the pancreas is often suboptimally visualized and characterization of pancreatic masses is poor." — Jamie Nathan (clinical) [Ep 1 · 13:40](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=820)
- "CT scan is rapidly acquired with good resolution but has downsides of radiation and need for contrast; it is often used for solid tumor staging." — Jamie Nathan (clinical) [Ep 1 · 14:00](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=840)
- "MRI provides better differentiation between solid and cystic or fluid components and can better characterize components of a pancreatic mass." — Jamie Nathan (clinical) [Ep 1 · 14:20](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=860)
- "Cross-sectional imaging (CT or MRI) cannot confidently differentiate a benign versus malignant pancreatic lesion." — Jamie Nathan (clinical) [Ep 1 · 15:03](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=903)
- "A completely cystic pancreatic lesion is less concerning for malignancy, but if the mass has solid components, it becomes more concerning for neoplasm." — Jamie Nathan (clinical) [Ep 1 · 15:25](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=925)
- "Pediatric EUS is not practical in many institutions because there are not many practitioners in the pediatric GI community comfortable with pediatric EUS." — Jamie Nathan (clinical) [Ep 1 · 17:20](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1040)
- "In the pediatric realm, autoimmune pancreatitis is more common than pancreatic neoplasm." — Jamie Nathan (epidemiological) [Ep 1 · 18:24](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1104)
- "With negative biliary cytology and after biliary and pancreatic duct stenting, a four-week steroid trial with taper can be initiated for presumed autoimmune pancreatitis, even if IgG4 findings are normal." — Jamie Nathan (clinical) [Ep 1 · 18:35](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1115)
- "Type 1 autoimmune pancreatitis is IgG4-mediated; type 2 autoimmune pancreatitis is IgG4-negative." — Jamie Nathan (clinical) [Ep 1 · 19:05](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1145)
- "Autoimmune pancreatitis with a pancreatic head mass is typically very steroid responsive, with rapid resolution of the mass in most cases." — Jamie Nathan (clinical) [Ep 1 · 20:03](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1203)
- "Studies report up to about a 10% risk of diabetes (endocrine impairment) after just a distal pancreatectomy in the setting of otherwise normal pancreas." — Jamie Nathan (epidemiological) [Ep 1 · 23:20](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1400)
- "For malignant pancreatic head lesions, a radical resection (Whipple pancreaticoduodenectomy) is required; for benign or borderline benign lesions, duodenum-preserving pancreatic head resections (Beger or Berne procedures) may be considered." — Jamie Nathan (clinical) [Ep 1 · 22:40](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1360)
- "Enucleation may be appropriate for pancreatic neuroendocrine tumors but should be used sparingly; it is not recommended for solid pseudopapillary neoplasms due to higher recurrence risk." — Jamie Nathan (clinical) [Ep 1 · 24:50](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1490)
- "Type 1 autoimmune pancreatitis is IgG4-related systemic disease involving multiple organs (sialoadenitis, sclerosing cholangitis, retroperitoneal fibrosis) and responds quickly to steroids; IgG4 levels are elevated in 90% of patients." — Jamie Nathan (clinical) [Ep 1 · 28:53](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1733)
- "Type 2 autoimmune pancreatitis is pancreas-specific with normal IgG4 levels; 30% of patients also have IBD. Histology shows idiopathic duct-centric pancreatitis." — Jamie Nathan (clinical) [Ep 1 · 29:40](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1780)
- "Over 90% of children with autoimmune pancreatitis present with abdominal pain; about 40% present with obstructive jaundice." — Jamie Nathan (epidemiological) [Ep 1 · 30:10](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1810)
- "Positive serologies for IgG4 are described in only 22% of children with autoimmune pancreatitis in one study." — Jamie Nathan (epidemiological) [Ep 1 · 30:30](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1830)
- "In pediatric autoimmune pancreatitis, focal enlargement in the pancreatic head occurs in about 50% of patients; global pancreatic enlargement in 30%; main pancreatic duct irregularity in two-thirds; common bile duct strictures in 55%; and the capsule-like rim sign in only 16%." — Jamie Nathan (epidemiological) [Ep 1 · 30:45](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1845)
- "93% of pediatric patients with autoimmune pancreatitis respond to steroids, indicating very steroid-responsive disease." — Jamie Nathan (epidemiological) [Ep 1 · 31:30](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1890)
- "Autoimmune pancreatitis in children more commonly follows a type 2 presentation rather than type 1 or IgG4-related presentation, based on data from the INSPIRE consortium and European pancreatic consortium." — Jamie Nathan (epidemiological) [Ep 1 · 32:30](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=1950)
- "Ideally, a tissue diagnosis should be obtained before initiating therapy for autoimmune pancreatitis, but barriers in pediatrics (limited EUS-skilled endoscopists and pathologists, inadequate biopsies) often cannot be overcome." — Jamie Nathan (clinical) [Ep 1 · 33:20](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=2000)
- "The diagnosis of autoimmune pancreatitis in children can be made with a combination of clinical and imaging findings because the risk of pediatric neoplasm is lower than autoimmune pancreatitis." — Jamie Nathan (guideline) [Ep 1 · 33:50](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=2030)
- "Clinical response to corticosteroid therapy for autoimmune pancreatitis should be seen within a few weeks; imaging response should be anticipated after about three months." — Jamie Nathan (clinical) [Ep 1 · 34:30](https://qa.library.globalcastmd.com/watch/pancreatic-masses-3439?t=2070)
- "Serous cystadenomas are benign lesions that may grow and become symptomatic, with rare case reports of malignant transformation, and about one-third are identified incidentally." — david skarda (clinical) [Ep 2 · 2:15](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=135)
- "Serous cystadenomas are cured by removal." — david skarda (clinical) [Ep 2 · 3:27](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=207)
- "Mucinous cystadenomas are more common in females and the majority are located in the tail of the pancreas." — david skarda (epidemiological) [Ep 2 · 3:54](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=234)
- "Mucinous cystadenomas are generally considered benign but potentially pre-malignant lesions and are removed." — david skarda (clinical) [Ep 2 · 4:17](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=257)
- "Mature cystic teratomas can arise anywhere within the pancreatic parenchyma and are oftentimes adjacent to the pancreas in the retroperitoneum." — david skarda (clinical) [Ep 2 · 4:51](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=291)
- "Mature cystic teratomas can contain malignancy and are resected based on symptoms and malignant potential." — david skarda (clinical) [Ep 2 · 5:19](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=319)
- "With the exception of serous cystadenoma which is probably totally completely benign, the mucinous versions and teratomas have enough malignant potential that biopsy may not make sense due to sampling error, and most will ultimately require resection." — david skarda (opinion) [Ep 2 · 7:21](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=441)
- "Solid pseudopapillary tumors are the most common in young women with a mean age of diagnosis of 28 years." — david skarda (epidemiological) [Ep 2 · 18:21](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1101)
- "Solid pseudopapillary tumors have a fairly benign course with some malignant potential, and complete surgical resection with clear margins is the treatment of choice." — david skarda (clinical) [Ep 2 · 18:32](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1112)
- "Enucleation is not considered adequate treatment for solid pseudopapillary tumors, unlike insulinomas." — david skarda (clinical) [Ep 2 · 18:55](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1135)
- "Overall survival with complete resection of solid pseudopapillary tumors is really good, and lymph node metastases are fairly rare." — david skarda (clinical) [Ep 2 · 19:08](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1148)
- "There is a relatively high percentage (15-20%) of solid pseudopapillary tumors that present with metastatic disease, but it's called a benign tumor, and survival is still quite good without adjuvant therapy even with metastases." — david skarda (clinical) [Ep 2 · 20:44](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1244)
- "In cases of solid pseudopapillary tumor with lung metastases, reported cases suggest resecting the primary tumor and letting metastatic deposits remain without requiring resection." — david skarda (clinical) [Ep 2 · 20:52](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1252)
- "Pancreatoblastoma is the most common malignant pancreatic tumor in young children, with a mean age of 5 years and occurring twice as commonly in males compared to females." — david skarda (epidemiological) [Ep 2 · 25:55](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1555)
- "Pancreatoblastomas are associated with Beckwith-Wiedemann syndrome and FAP, with some tumors having genetic abnormalities on chromosome 11p15." — david skarda (clinical) [Ep 2 · 26:10](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1570)
- "In a fairly high percentage of pancreatoblastomas, alpha-fetoprotein is elevated, which can be used to monitor for recurrence after removal of the mass." — david skarda (clinical) [Ep 2 · 27:19](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1639)
- "Mucinous cystadenocarcinomas are challenging to differentiate from mucinous cystadenomas, and histologically they can appear benign but frequently have foci of dysplastic or frankly malignant epithelium, making sampling a problem." — david skarda (clinical) [Ep 2 · 31:20](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1880)
- "Mucinous cystadenocarcinomas are managed by complete excision, usually consisting of spleen-sparing distal pancreatectomy with adequate margins, and adjuvant chemotherapy can be considered for unresectable or metastatic disease, though efficacy is poorly understood." — david skarda (clinical) [Ep 2 · 32:15](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1935)
- "Acinar cell adenocarcinomas in young children (around 3 years old) tend to be well-circumscribed masses that occur more commonly in males than females and can be equally distributed throughout the pancreas." — david skarda (epidemiological) [Ep 2 · 32:48](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1968)
- "Acinar cell adenocarcinomas have areas of necrosis on imaging, vascular invasion is rare, and complete removal essentially results in cure without need for adjuvant chemotherapy or radiation." — david skarda (clinical) [Ep 2 · 33:14](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=1994)
- "Acinar cell adenocarcinomas have a much better prognosis than typical ductal adenocarcinoma." — david skarda (clinical) [Ep 2 · 33:40](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2020)
- "Pancreatic ductal adenocarcinomas are extremely rare in young people and when they occur are often associated with FAP, Peutz-Jeghers syndrome, or hereditary pancreatic cancer syndrome." — david skarda (epidemiological) [Ep 2 · 33:49](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2029)
- "Pancreatic ductal adenocarcinomas are firm, invasive tumors that frequently occur in the head of the pancreas and can cause obstructive jaundice by blocking the common bile duct." — david skarda (clinical) [Ep 2 · 34:20](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2060)
- "Treatment of pancreatic ductal adenocarcinoma depends on tumor size, location, invasion, and resectability at time of diagnosis, potentially requiring palliative bypass procedures similar to adult patients." — david skarda (clinical) [Ep 2 · 34:44](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2084)
- "Insulinoma is the most common pancreatic neuroendocrine tumor and is a beta islet cell neoplasm that produces excessive insulin resulting in hypoglycemia." — david skarda (clinical) [Ep 2 · 36:12](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2172)
- "Insulinomas tend to be small, relatively well encapsulated, and because they make insulin, can be diagnosed fairly early." — david skarda (clinical) [Ep 2 · 36:33](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2193)
- "The classic diagnostic findings for insulinoma are Whipple's triad: signs and symptoms of hypoglycemia, documented hypoglycemia during the symptomatic period, and resolution of symptoms with glucose administration." — david skarda (clinical) [Ep 2 · 36:43](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2203)
- "Children with insulinomas tend to have symptoms for less than a year before diagnosis." — david skarda (epidemiological) [Ep 2 · 36:58](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2218)
- "C-peptide levels are checked in suspected insulinoma to ensure the insulin is not exogenous (not from insulin injections)." — david skarda (clinical) [Ep 2 · 38:57](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2337)
- "Biochemical diagnosis of insulinoma includes elevated insulin and C-peptide levels with beta-hydroxybutyric acid level less than 2.7, with blood sugar rising after glucose administration." — david skarda (clinical) [Ep 2 · 39:12](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2352)
- "Insulinomas tend to be relatively well encapsulated and surprisingly do not have blood vessels attached to them despite being endocrine tumors that secrete into the bloodstream." — david skarda (clinical) [Ep 2 · 40:39](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2439)
- "Insulinomas can be enucleated and they pop out like a grape, with the main concern being the relationship of the tumor to the pancreatic duct." — david skarda (clinical) [Ep 2 · 41:17](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2477)
- "Endoscopic ultrasound is really good at finding insulinomas, and intraoperative ultrasound allows visualization of the relationship of the mass to the pancreatic duct." — david skarda (clinical) [Ep 2 · 41:52](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2512)
- "Sporadic insulinomas in children are often isolated and benign, while those with MEN1 tend to be multifocal and have a higher incidence of malignancy." — david skarda (clinical) [Ep 2 · 45:20](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2720)
- "Gastrinomas are very rare in children and result in unregulated secretion of gastrin leading to hypergastrinemia and excessive stomach acid production with resulting ulcers in the stomach and duodenum (Zollinger-Ellison syndrome)." — david skarda (clinical) [Ep 2 · 45:35](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2735)
- "Eighty percent of gastrinomas occur sporadically, while 20% occur in the setting of MEN1, with MEN1-associated lesions tending to be multicentric, malignant, presenting at higher rates of metastasis and at younger ages." — david skarda (epidemiological) [Ep 2 · 46:03](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2763)
- "About 60% of gastrinomas are not in the pancreas but are located in the wall of the duodenum, typically between where the common bile duct inserts and the junction of the second and third portion of the duodenum." — david skarda (clinical) [Ep 2 · 47:12](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2832)
- "Gastrinomas can be palpated surgically, though imaging is not super great for locating them." — david skarda (clinical) [Ep 2 · 47:31](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=2851)
- "In adult algorithms for small incidental pancreatic cysts less than 2 centimeters, if biopsy shows serous content, observation with surveillance is acceptable, though the appropriate surveillance duration in adolescents is uncertain." (opinion) [Ep 2 · 10:56](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=656)
- "For cystic pancreatic lesions, fluid should be sent for amylase and lipase, which theoretically should be elevated in a pseudocyst and not necessarily in neoplastic lesions." (clinical) [Ep 2 · 12:17](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=737)
- "The reason for surveillance of presumed benign pancreatic lesions may be primarily to ensure diagnostic accuracy rather than to monitor for malignant degeneration, and if a lesion is stable for 5 years in a child, annual MRI surveillance may not be necessary indefinitely." (opinion) [Ep 2 · 12:37](https://qa.library.globalcastmd.com/watch/pancreatic-tumors-presented-by-david-skarda-md-04-10-23-video-6583?t=757)

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Aug 31: 3 doctors auto-found from episode dossiers
- Aug 30: 1 doctors auto-found from episode dossiers
- Aug 30: 1 doctors auto-found from episode dossiers
- Aug 29: 1 doctors auto-found from episode dossiers
- Aug 29: 1 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 2 items, 1 dossiers, summaries for 3 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 1 items, 1 dossiers, summaries for 4 audience(s)

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Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://qa.library.globalcastmd.com/ai