A 70-year-old man is found to have a 3 cm main pancreatic duct (MPD)-type intraductal papillary mucinous neoplasm (IPMN) with MPD dilation of 12 mm. According to the revised Fukuoka guidelines (Gut 2017), this finding warrants:
- A Annual MRI surveillance
- B Resection, as MPD dilation ≥10 mm is a high-risk stigma ✓
- C EUS-FNA to assess cytology before deciding
- D No intervention if asymptomatic; repeat imaging in 2 years
Correct answer: B. Resection, as MPD dilation ≥10 mm is a high-risk stigma
Explanation
The revised Fukuoka/international consensus guidelines identify MPD dilation ≥10 mm as a 'high-risk stigma' for malignancy in IPMN, mandating surgical resection in fit patients regardless of symptoms. Other high-risk stigmata include obstructive jaundice, enhancing mural nodule ≥5 mm, and positive cytology. 'Worrisome features' (MPD 5–9 mm, mural nodule <5 mm, cyst ≥3 cm) indicate EUS evaluation. MPD-type IPMN has a 40–90% risk of high-grade dysplasia or invasive carcinoma.
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.