A 72-year-old woman with incidental 2.5 cm main duct IPMN (intraductal papillary mucinous neoplasm) of the pancreas has a main pancreatic duct of 8 mm on MRI. She has no jaundice or weight loss. Per Fukuoka guidelines, the most appropriate management is:

• A 6-monthly MRI/EUS surveillance
• B Annual CT surveillance only
• C EUS-guided FNA for cytology before deciding
• D Surgical resection is strongly recommended ✓

Explanation

According to the 2017 Fukuoka guidelines, main duct IPMN with main pancreatic duct (MPD) dilation ≥10 mm is an absolute indication for surgery. MPD of 5–9 mm is a worrisome feature (not absolute indication) but combined with a cyst >3 cm warrants further evaluation (EUS). Here the MPD is 8 mm — a worrisome feature — and the cyst is 2.5 cm; however, MPD involvement of ≥5 mm with high suspicion features in a fit patient generally leads to recommendation for resection, particularly main duct type.

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.