A 50-year-old male incidentally found to have a 35 mm main-duct intraductal papillary mucinous neoplasm (MD-IPMN) of the pancreatic body on CT. He is asymptomatic with no obstructive jaundice. On MRI, main pancreatic duct diameter is 12 mm. According to the 2017 International Fukuoka Guidelines, which of the following represents a 'high-risk stigmata' mandating surgical resection?
- A Main duct dilation 5–9.9 mm
- B Cyst size >3 cm without mural nodule
- C Main duct dilation ≥10 mm ✓
- D Thickened cyst wall on imaging
Explanation
The 2017 Fukuoka guidelines define 'high-risk stigmata' (absolute indications for surgery) for IPMN as: obstructive jaundice with cystic lesion in pancreatic head, enhancing solid component within the cyst, and main pancreatic duct dilation ≥10 mm. This patient's 12 mm MD dilation fulfils the high-risk stigmata criterion; surgical resection is indicated without delay. Main duct dilation of 5–9.9 mm constitutes a 'worrisome feature' (relative indication) along with cyst ≥3 cm, thickened wall, non-enhancing mural nodule, and abrupt change in duct calibre. Cyst size >3 cm alone is a worrisome feature, not a high-risk stigmata.
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.