Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is classified as main-duct, branch-duct, or mixed type. Which radiological finding is an absolute indication for surgical resection according to Fukuoka guidelines?
- A Main pancreatic duct dilatation ≥10 mm or presence of an enhancing mural nodule ≥5 mm ✓
- B Branch-duct IPMN measuring 15 mm without mural nodule
- C Main pancreatic duct dilatation of 5–9 mm with no other worrisome features
- D Rapid cyst growth of 2–3 mm per year in a branch-duct IPMN
Correct answer: A. Main pancreatic duct dilatation ≥10 mm or presence of an enhancing mural nodule ≥5 mm
Explanation
The Fukuoka/International Consensus Guidelines define 'high-risk stigmata' as absolute indications for surgery in IPMN: (1) obstructive jaundice in a patient with cystic lesion of the pancreatic head, (2) enhancing solid component or mural nodule ≥5 mm, and (3) main pancreatic duct dilatation ≥10 mm. 'Worrisome features' (e.g., MPD 5–9 mm, cyst growth ≥2.5 mm/year, serum CA19-9 elevation, cyst size ≥3 cm) require enhanced MRI and EUS evaluation but not immediate surgery. Distinguishing high-risk stigmata from worrisome features is critical for NEET PG examination.
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.