A 55-year-old male has a 4 cm branch-duct IPMN (intraductal papillary mucinous neoplasm) of the pancreatic head with a mural nodule of 7 mm on MRI and a dilated main pancreatic duct of 6 mm. According to the revised Fukuoka guidelines (2017), what is the appropriate management?

• A Surgical resection given the presence of a worrisome feature (mural nodule) and high-risk stigmata (MPD dilation ≥5 mm) ✓
• B Annual MRI surveillance as branch-duct IPMNs are rarely malignant
• C EUS-guided fine needle aspiration alone for definitive diagnosis before any intervention
• D 3-monthly MRI for 2 years then annual surveillance if stable

Explanation

The 2017 revised Fukuoka/IAP guidelines classify IPMN features into 'high-risk stigmata' (obstructive jaundice with cystic lesion, enhancing solid component within cyst, MPD ≥10 mm) and 'worrisome features' (cyst ≥3 cm, enhancing mural nodule <5 mm, MPD 5–9 mm, abrupt change in MPD calibre, lymphadenopathy, cyst growth ≥5 mm/2 years, elevated CA 19-9). This patient has both a mural nodule (≥5 mm qualifies as high-risk stigmata for enhancing solid component) and MPD ≥5 mm — these are indications for surgical resection after EUS evaluation.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.