MRCP in a 55-year-old woman shows a cystic lesion in the pancreatic head communicating with the main pancreatic duct (MPD), with dilated MPD >5 mm and mural nodules within the cyst. What is the diagnosis and the recommended management?
- A Serous cystadenoma — honeycomb/microcystic pattern; surveillance only
- B Mucinous cystic neoplasm — no ductal communication; resect if >3 cm
- C Pseudocyst — amylase-rich fluid; treat conservatively
- D Main-duct IPMN (intraductal papillary mucinous neoplasm) — high malignancy risk; surgical resection recommended ✓
Explanation
Intraductal papillary mucinous neoplasm (IPMN) of the main duct type shows communication of the cyst with the MPD (pathognomonic), MPD dilatation ≥5 mm, and mural nodules — all high-risk stigmata per 2023 Fukuoka/IAP guidelines mandating surgical resection due to ≥50% risk of malignancy. Branch-duct IPMNs communicating with a normal-caliber MPD may be surveilled if low-risk features. Serous cystadenomas show a honeycomb/microcystic pattern with central calcification ('sunburst') and no ductal communication. Mucinous cystic neoplasms lack pancreatic ductal communication. Pseudocysts arise in the clinical context of pancreatitis.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.