Successful Localization and Resection of Small Pancreatic Cystic Insulinoma Using Intraoperative Near-Infrared Fluorescence Imaging: A Case Report and Literature Review

Pancreatic cystic insulinoma is an uncommon tumor. Perioperative localization remained challenging if the tumor is atypical with cystic feature or in small size. Near-infrared (NIR) imaging is a technique by injecting fluorescent dye intravenously, which accumulates to the target lesion and creating signal by laser sources. The signal helps surgeons to identify the lesion during operation, but little experience has been reported regarding the use of imaging NIR technique for localizing cystic insulinoma. We present a 29-year-old female patient with a symptomatic pancreatic cystic insulinoma (1.2 cm) as assessed by clinical symptom, laboratory evidence, and magnetic resonance cholangiopancreatography. With an aid of NIR imaging technique, this cystic tumor was localized easily at operation. Also, the fluorescence imaging visualized the tumor part, guided us to identify the safe margin, and preserved the normal pancreatic structure. Pathologic report confirmed that the tumor was a well-differentiated cystic insulinoma. This case demonstrates that pancreatic cystic insulinoma in small size can be intraoperatively localized by NIR imaging, a relatively safe and easy technique.