MRCP of a 45-year-old male with recurrent pancreatitis shows a dilated main pancreatic duct communicating with a 3 cm cystic lesion in the head of pancreas. The cyst has mural nodules and the main duct is >5 mm. According to Fukuoka criteria, this lesion should be:
- A Surgically resected — high-risk stigmata present ✓
- B Observed with 12-monthly MRI — no worrisome features
- C Drained endoscopically — it is a pseudocyst
- D Observed with 6-monthly MRI only
Explanation
The Fukuoka (2017 IAP) guidelines classify IPMN (intraductal papillary mucinous neoplasm) features into high-risk stigmata and worrisome features. High-risk stigmata mandating surgery include: main duct diameter ≥10 mm, obstructive jaundice from cyst, enhancing mural nodule ≥5 mm, and positive cytology. Worrisome features include: cyst ≥3 cm, main duct 5–9 mm, non-enhancing mural nodule, abrupt MPD calibre change, and growth ≥5 mm/2 yr. This patient has mural nodules (concern for high-risk stigmata if enhancing ≥5 mm) and main duct >5 mm — qualifying as worrisome/high-risk, warranting surgical resection.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.