Cystic echinococcosis (CE), a zoonotic disease caused by Echinococcus granulosus sensu lato, is endemic in the Mediterranean, where pastoral activity is widespread, as the life cycle of this helminth involves sheep, as well as other livestock, as intermediate hosts. We review recent studies on CE from Mediterranean countries. Reliable data on CE, from human and animal epidemiology to treatment, remain fragmented and insufficient to gauge the magnitude of the problem beyond local communities. The lack of major advances leaves clinicians without an evidence base on which to make sound clinical decisions. Despite a wealth of publications on the subject, CE remains a neglected disease in the Mediterranean as well. Hope is seen in the establishment of a European Registry for Cystic Echinococcosis, but implementation and maintenance of such an important tool will require hard work, political commitment and resources, monetary, and otherwise.