A 72-year-old woman has an incidentally found 3.5 cm main duct intraductal papillary mucinous neoplasm (MD-IPMN) of the pancreatic head with main duct diameter 12 mm. What is the recommended management?

• A Surveillance with MRI every 6 months
• B EUS-guided FNA for cytology before deciding on surgery
• C Observation — main duct IPMN has low malignant potential
• D Surgical resection given high malignancy risk ✓

Explanation

Main duct IPMN with a dilated main pancreatic duct ≥10 mm carries an approximately 60–70% malignancy risk and is an absolute indication for surgery in fit patients, according to IAP (Fukuoka) and European guidelines. Additional high-risk stigmata (obstructive jaundice, enhancing mural nodule, positive cytology) further increase this risk. Surveillance is appropriate for branch duct IPMN <3 cm without worrisome features. EUS-FNA may be performed but does not change the surgical indication for main duct dilatation ≥10 mm in a candidate for 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.