INTRODUZIONELe neoplasie mucinose cistiche del pancreas possono essere classificate in due gruppi ben distinti: neoplasie papillari mucinose intraduttali (IPMN) e neoplasie mucinose cistiche (MCN) (Tabella I).Queste ultime sono maligne o potenzialmente tali anche se con una crescita molto lenta rispetto alle IPMN [2]. Spesso interessano donne di mezza età e la sintomatologia di esordio consiste principalmente in dolore addominale e presenza di una massa palpabile in epigastrio. Sono solitamente localizzate nella coda del pancreas e sono costituite da cisti mucinose uniloculari o multiloculari ben circoscritte con dimensioni medie di 7-10 cm [3,4] Caso clinico AbstractThree distinct entities among non-inflammatory cystic lesions of the pancreas have been defined: intraductal papillary mucinous neoplasm (IPMN), serous cystic neoplasm (SCN) and mucinous cystic neoplasm (MCN). IPMN is characterized by intraductal papillary growth and thick mucus secretion: its incidence has dramatically increased since its initial description. These lesions probably can progress towards invasive carcinoma. IPMNs are symptomatic in most cases: the typical presentation is a recurrent acute pancreatitis, without evident cause, of low or moderate severity. The diagnosis is usually based upon the imaging (CT/cholangio-MRI) demonstrating a pancreatic cystic mass, involving a dilated main duct, eventually associated to some filling defects, or a normal Wirsung duct communicating with the cyst lesion. Surgical treatment is generally indicated for main duct IPMN and branch duct IPMN with suspected malignancy (tumour size ≥ 30 mm, mural nodules, dilated main pancreatic duct, or positive cytology) or prominent symptoms. Herein we present a case of IPMN of the main duct which occurred with abdominal and back pain associated with weight loss. After the diagnosis, she successfully underwent surgery and is now in a follow-up program.

Sarcoidosis is a multisystemic disease of unknown aetiology characterized by proliferation of noncaseating granulomas at disease sites. It commonly affects young and middle-age adults and frequently presents with pulmonary infiltration, bilateral hilar lymphadenopathy, ocular and skin lesions. The liver, spleen, lymph nodes, salivary glands, heart, nervous system, muscles, bones, and other organs may also be involved. A diagnosis of the disorder usually requires the demonstration of typical lesions in more than one organ system and exclusion of other disorder known to cause granulomatous inflammation. We present the case of a young woman with abdominal pain and weight loss. The finding of splenomegaly by abdominal ultrasound and the presence of hypercalciuria, hypercalcemia and mild renal impairment led us to include sarcoidosis in the differential diagnosis. The final diagnosis was established by demonstration of involvement of lymph nodes and lung parenchyma on CT scan, and typical histology in bioptic specimens collected from bronchial mucosa.