An incidental cystic pancreatic lesion is found on CT in a 58-year-old asymptomatic man — a unilocular 22 mm cyst in the body of the pancreas with no solid component or main duct dilation. MRI/MRCP confirms a branch duct intraductal papillary mucinous neoplasm (BD-IPMN). According to Fukuoka 2017 guidelines, the most appropriate management is:

• A Immediate surgical resection due to malignant potential
• B Annual MRI/CT surveillance as the cyst is <30 mm with no worrisome features
• C Endoscopic ultrasound with FNA for cyst fluid analysis
• D Follow up in 6 months then annually if stable ✓

Explanation

The Fukuoka 2017 (revised) International Consensus Guidelines for BD-IPMN stratify management by 'worrisome features' (3–3 cm cyst size, enhancing mural nodule, thickened walls, MPD 5-9 mm, abrupt MPD caliber change, lymphadenopathy) and 'high-risk stigmata' (obstructive jaundice, enhancing solid component, MPD ≥10 mm). A 22 mm unilocular BD-IPMN with no worrisome features warrants surveillance: initial follow-up at 6 months then annually if stable. Cysts <30 mm without worrisome features do not require EUS-FNA or immediate resection.

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.