MRCP in a 50-year-old woman with recurrent episodes of acute pancreatitis shows a 4 cm cystic lesion in the head of the pancreas that communicates with a dilated main pancreatic duct (7 mm) via a narrow stalk. The lesion has a lobulated contour and tiny filling defects within it. The MOST likely diagnosis is:
- A Mucinous cystic neoplasm (MCN)
- B Intraductal papillary mucinous neoplasm (IPMN), main-duct type ✓
- C Serous cystadenoma
- D Mucinous cystic neoplasm with ovarian stroma
Correct answer: B. Intraductal papillary mucinous neoplasm (IPMN), main-duct type
Explanation
Main-duct IPMN is characterized by segmental or diffuse dilatation of the main pancreatic duct (>5 mm) communicating with a cystic lesion, often with visible mucin as filling defects. MCN does not communicate with the pancreatic duct and occurs almost exclusively in women with ovarian-type stroma. Serous cystadenoma is microcystic with a central scar and does not communicate with the duct.
Reference: Hepatobiliary and Pancreatic Imaging (Gillian), Standard edition ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.