A 55-year-old woman is found to have a 3 cm cystic lesion in the head of the pancreas with a dilated main pancreatic duct of 8 mm on MRI. MRCP shows communication between the cyst and the main pancreatic duct. Endoscopic ultrasound shows mural nodules. What is the most appropriate management?
- A Surveillance MRI in 6 months
- B Surgical resection (Whipple's procedure) ✓
- C Cyst aspiration and CEA measurement
- D Endoscopic drainage of the cyst
Correct answer: B. Surgical resection (Whipple's procedure)
Explanation
This lesion is an intraductal papillary mucinous neoplasm (IPMN) of the main duct type (main pancreatic duct ≥5 mm and communication with cyst). Main duct IPMNs carry a significant malignancy risk (25-60%), and the presence of mural nodules is a high-risk stigmata per the revised international Fukuoka guidelines. Surgical resection is strongly recommended when high-risk stigmata are present, regardless of patient symptoms. Surveillance is insufficient for main-duct IPMN with mural nodules.
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.