PARTIAL OR NEAR-TOTAL PANCREATECTOMY FOR PERSISTENT NEONATAL HYPERINSULINEMIC HYPOGLYCEMIA - THE PATHOLOGISTS ROLE

Aims: To determine whether the presence of abnormal B-cell nuclei pred icts the existence of a focal or of a diffuse form of persistent neona tal and infantile hyperinsulinaemic hypoglycaemia in a series of 20 in fants, Methods and results: Intra-operative frozen sections were perfo rmed on small specimens from the pancreatic head, isthmus and tail, In 13 cases, abnormal B-cell nuclei were identified, but even a near-tot al pancreatectomy was insufficient to cure some of these patients, in whom no focal lesion was detected, On the other hand, abnormal insular B-cell nuclei were not found in seven cases; based on the results of selective venous catheterization, a limited resection was performed, s ufficient to cure each patient, and a focal adenomatous hyperplasia wa s found in each resected specimen, Conclusions: Intra-operative examin ation of small pancreatic specimens taken from the different parts of the gland allows one to determine the type of lesion (focal or diffuse ) in neonatal onset hyperinsulinaemic hypoglycaemia, and to decide on the most appropriate surgical treatment.