IPMN (intraductal papillary mucinous neoplasm) of the pancreas is classified by duct involvement. Which subtype carries the highest risk of harboring invasive carcinoma and warrants resection in fit patients?
- A Branch duct IPMN <1 cm without worrisome features
- B Mixed-type IPMN without mural nodules or pancreatitis
- C Main duct IPMN (dilation ≥5 mm) — absolute indication for resection in fit patients ✓
- D Branch duct IPMN 2–3 cm with stable appearance over 2 years
Correct answer: C. Main duct IPMN (dilation ≥5 mm) — absolute indication for resection in fit patients
Explanation
Main duct IPMN (MD-IPMN, main pancreatic duct ≥5 mm without other cause) carries a 40–70% rate of malignancy (high-grade dysplasia or invasive carcinoma) and is an absolute indication for surgical resection in fit patients per IAP (Fukuoka/Kyoto) guidelines 2017. Branch duct IPMNs have a much lower risk (~25%) but require resection if 'high-risk stigmata' (enhancing mural nodule, main duct ≥10 mm, obstructive jaundice) are present. Small branch duct IPMNs without worrisome features undergo surveillance.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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