A 60-year-old man is found to have a 28 mm pancreatic body cystic lesion on CT. EUS shows it communicates with the main pancreatic duct and the duct is dilated to 7 mm. Cytology shows mucinous cells with high-grade dysplasia. What is this lesion and the appropriate management?
- A IPMN with main duct involvement and high-grade dysplasia; surgical resection is indicated ✓
- B Serous cystadenoma; surveillance only as malignant potential is negligible
- C Pseudocyst; endoscopic drainage via EUS-guided cyst-gastrostomy
- D Mucinous cystic neoplasm; surveillance with repeat EUS in 6 months
Correct answer: A. IPMN with main duct involvement and high-grade dysplasia; surgical resection is indicated
Explanation
Main duct intraductal papillary mucinous neoplasm (MD-IPMN) with main pancreatic duct dilatation ≥5-10 mm is a high-risk feature mandating surgical resection given significant risk of invasive carcinoma (>40%). High-grade dysplasia on cytology is an absolute indication for surgery (Fukuoka/European guidelines). This lesion communicates with the main duct (distinguishing from MCN which does not), and has a dilated MPD — both worrisome/high-risk features. Surveillance is only appropriate for branch-duct IPMN with no high-risk features.
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.