A 58-year-old man with recurrent acute pancreatitis has MRCP showing a 22 mm cyst communicating with a uniformly dilated main pancreatic duct measuring 8 mm throughout its length, with no mural nodule. CA 19-9 is within normal limits. According to current international consensus (Fukuoka) guidelines, the appropriate recommendation is:

• A Surveillance every 6 months with EUS, as the malignancy risk is under 5 percent
• B Total pancreatectomy regardless of location
• C Endoscopic cystogastrostomy for drainage
• D Surgical resection, because main duct involvement confers a high risk of advanced neoplasia ✓

Explanation

Intraductal papillary mucinous neoplasm with main pancreatic duct dilatation of 5 mm or greater qualifies as main duct or mixed type IPMN, which harbours invasive cancer in a majority of resected specimens and is an absolute indication for surgery. Branch duct lesions below 30 mm without nodules can be surveilled. Drainage procedures treat pseudocysts, not neoplastic epithelium, and leave premalignant tissue behind.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.