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Cystic lesions of the pancreas are encountered frequently in clinical practice. Cystic neoplasms of the pancreas are much less common. In order to diagnose and most effectively treat these lesions, the surgeon must understand their clinical presentation in order to plan appropriate preoperative evaluation and therapeutic intervention. The following is a descriptive outline of the most common types of cystic neoplasms of the pancreas and a discussion of their preoperative, intraoperative, and postoperative management. The goal of the paper is to provide a functional understanding of cystic neoplasms of the pancreas so that they may be recognized and appropriately treated.

Eosinophilic gastroenteritis is a quite uncommon clinical entity usually involving the stomach or small bowel. Occasionally, the colon is involved. We have encountered a case of eosinophilic colitis leading to a left-sided colocolonic intussusception and subsequent large bowel obstruction. This is a unique presentation that, to our knowledge, has not been previously reported. We present our case in detail as well as a review of the literature to better understand this rare clinical entity.

Pheochromocytomas are functioning paragangliomas often presenting with paroxysmal hypertension due to catecholamine secretion. The preferential diagnostic workup includes urine and serum catecholamine measurements. Therapeutic management consists of pharmacologic cardiovascular manipulation and volume expansion with subsequent surgical resection. We have encountered a symptomatic pheochromocytoma in a chronic renal insufficiency patient on hemodialysis. The diagnostic dilemma arose due to the patient's anuric status and the inherent increase in serum catecholamine levels noted in anuric patients. The therapeutic dilemma arose in the proper pharmacologic management and volume expansion in this patient on hemodialysis. The patient underwent successful resection of the pheochromocytoma and has done well. An analysis of our diagnostic and therapeutic processes as well as a review of the literature are presented to assist in the management of this difficult clinical situation.

We have undertaken a review of the small bowel carcinoids treated at Georgia Baptist Medical Center during the last 27 years in order to evaluate the clinical behavior, diagnostic approaches, treatment options, and prognosis of these neoplasms. A retrospective analysis of the tumor registry at Georgia Baptist Medical Center was undertaken. A total of 148 cases of carcinoid tumors were identified. Of these, 34 were located in the small bowel. Twenty-eight of these cases were diagnosed at our institution. The others were referred for oncology care. The patient records were reviewed for sex, race, age at presentation, location, 5-HIAA status, coexistent neoplasms, multifocality, size, metastatic status, clinical presentation, diagnostic intervention, extension, adjuvant therapy, treatment intervention, and survival. A review of the available literature was undertaken to analyze the historical results in the aforementioned categories. In retrospect, many of these tumors had been clinically active for some time. The authors outline a more aggressive workup in order to avoid acute, in extremis, and late stage presentation. We present an analysis of traditional views on survival and prognosis as related to the size and spread of small bowel carcinoid. We expect that this information will assist in the development of definitive treatment, effective adjuvant therapy, and symptomatic relief for this often frustrating neoplasm.

The adult rhabdomyoma (ARM) is an unusual and extremely uncommon tumor. Only 96 cases have been reported. Adult rhabdomyomas are found most often in the region of the base of the tongue, floor of the mouth, larynx, and pharynx. Uncommon locations include the soft palate, uvula, lip and cheek, orbit, and stomach. One prior case of extension of an ARM from the supraclavicular region into the mediastinum has been described as an incidental finding at autopsy. It is important to be aware of and correctly identify this tumor because total excision may be curative. Follow-up must be long-term, as recurrence can occur after 35 years. The authors present a case of an ARM diagnosed during the evaluation and treatment of a symptomatic mediastinal mass. This ARM was found to involve the esophagus and trachea from the inferior constrictors in the neck to the azygous vein in the mediastinum. This case represents a previously undescribed presentation of an ARM. We present a review of ARM and outline our diagnostic, therapeutic, and follow-up plans.