Intraductal papillary mucinous neoplasm (IPMN) of the pancreas — 'worrisome features' per the Fukuoka 2017 consensus guidelines include which of the following?
- A Main duct diameter ≥10 mm and mural nodule without contrast enhancement
- B Main duct diameter ≥10 mm with obstructive jaundice — these are 'high-risk stigmata'
- C Cyst size ≥3 cm, enhancing mural nodule <5 mm, abrupt change in main duct calibre with distal atrophy ✓
- D Cyst size ≥1 cm with elevated CA 19-9
Correct answer: C. Cyst size ≥3 cm, enhancing mural nodule <5 mm, abrupt change in main duct calibre with distal atrophy
Explanation
Fukuoka 2017 distinguishes high-risk stigmata (require surgery: obstructive jaundice with cystic lesion, enhancing solid component, MPD ≥10 mm) from worrisome features (require EUS evaluation: pancreatitis, cyst ≥3 cm, enhancing mural nodule <5 mm, thickened walls, MPD 5–9 mm, abrupt MPD calibre change with upstream atrophy, lymphadenopathy, elevated CA19-9, rapid cyst growth). Management decisions hinge on distinguishing these two categories.
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.