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Pancreatic exocrine neoplasms represent a wide spectrum of pathophysiologic entities that challenge us as surgeons. The workup and management of these lesions continue to evolve as we better understand their complex nature. In this review, we will explore the contemporary clinical management of pancreatic adenocarcinoma, acinar cell carcinoma, and cystic neoplasms of the pancreas. The pathogenesis and epidemiology of these tumors will also be examined.

Cystic neoplasms of the pancreas constitute about 9% of all cystic lesions of the pancreas and less than 1% of all pancreatic neoplasms. The case of a 70 years-old woman with microcystic cystadenoma is reported. CT-scan of the abdomen diagnosed a 5 cm multilocular septated cyst, with calcifications in the context, localized in the head-uncinate process of the pancreas. The mass was well separated by a sharp cleavage plane with portal vein and superior mesenteric vessels. An ERCP showed cephalic symmetrical stenosis (diameter 3 mm) of the main pancreatic duct (MPD), mildly dilated in the remaining tract (diameter 6 mm). An intraoperative biopsy of the cystic wall was performed. Therefore, it was decided to proceed with a duodenum-preserving resection of the head of the pancreas (DPPHR), including the stenosis tract of the MPD in the surgical specimen. The reconstructive procedure consisted, by i.v. jejunal loop transposition, in a side-to-side pancreatico-jejunostomy, including in the anastomosis both corpocaudal stump and the resection cavity of the pancreatic head, and an end-to-side Roux-en-Y jejuno-jejunostomy. With respect to long-lasting pain relief and preservation of the endocrine and exocrine functions of the pancreas, DPPHR is a highly effective surgical procedure with a low early and late morbidity and mortality due to limited surgical resection. This technique, introduced into surgical practice by Beger, is indicated in patients with chronic pancreatitis with an inflammatory mass in the head of the pancreas. The authors conclude that this procedure can be performed also in case of pancreatic benign tumors, as microcystic cystadenoma. Advantages of this technique makes DPPHR an attractive alternative to Pylorus-Preserving-Pancreatico-Duodenectomy (PPPD).

Two cases of cystadenoma of the biliary tract are presented. This is a rare tumor that represents less than 5% of non parasitic cysts of biliary origin. It usually occurs in middle-aged women. Ultrasound (US) and Computerized Tomography (CT) are most important for tumor diagnosis, but differential diagnosis with other cystic tumors of the liver is very difficult preoperatively. Malignant degeneration to biliary cystadenocarcinoma is documented. Surgery is always indicated and has included aspiration, sclerosis, marsupialization, internal drainage, but the complete removal of lesion with enucleation or liver resection is the treatment of choice.

Personal experience in a case of ovarian cystoma (misunderstood to the patient herself) broken consequently to a car trauma and cause of an intracystic angiorrhagy and hemoperitoneum is presented. The advantages of videolaparoscopic technique both for the diagnosis formulation and for the surgical treatment are underlined and the use of this new technique is suggested due to its advantages such as quickness, mini-invasiveness and post-operation comfort.

After a discussion of ovarian tumour classification, two cases of giant neoplasm, one benign the other malignant are reported. Ultrasonography and CA125 research represent two irreplaceable investigations, for preoperative balance and for therapeutic strategy.

A case of biliary cystadenoma is reported. The neoplasm was located at the left lobe of the liver and its diameter was 18 cm. It presented with abdominal swelling and palpable mass in epigastric region. A left hepatectomy was performed, to achieve a complete resection of the tumor.

The case of a voluminous serous cystadenoma of the ovary in a young woman is reported. At a time when health education and diagnostic progress have significantly modified the evolution of such neoplastic growths, the remarkable size of the tumour (28 litres of serous liquid), the absence of any complications whatsoever and the youth of the patient make the case particularly interesting and trigger a number of remarks on social factors.

A case of papilliferous cystadenocarcinoma of the body and tail of the pancreas marked by unusually slow progresion is presented. It is pointed out that total resection, of the tumour is always necessary. This is also true of cystadenoma, which has a tendency to become malignant.

Primary tumours of the epididymis are rare and one of the rarest is papillary cysto-adenomas. For this reason, a case arising in a patient with Grade III varicocele seemed worth reporting. The report discusses the clinical case and describes the histological characteristics of the tumour.

On the basis of two personal cases and a review of the most recent literature, the main features of this rare pancreatic condition are reported. Special attention is paid to the post-diagnostic importance of radical exeresis. This is the only way of preventing the patient running the risk of malignant degeneration. The observation of a bisalbuminaemic band and the association with an aberrant pancreatic adenoma were of interest in the two cases described.