A 52-year-old man undergoes EUS evaluation of a 2 cm cystic pancreatic lesion. Cytology shows mucin-rich epithelium and communication of the cyst with the main pancreatic duct, which measures 11 mm diffusely. Serum CA 19-9 and carcinoembryonic antigen are normal. The recommended management is:

• A Surveillance imaging every 12 months
• B Resection only if cytology shows high-grade dysplasia
• C Alcohol ablation of the cyst
• D Surgical resection irrespective of symptoms ✓

Explanation

Involvement of the main pancreatic duct defines main-duct intraductal papillary mucinous neoplasm. Unlike branch-duct lesions, main-duct IPMN carries malignancy rates approaching 60 to 70 percent, so resection is advised in fit patients regardless of size, symptoms or cyst fluid markers. Normal serum tumour markers do not downgrade this risk. Branch-duct IPMNs under 3 cm without mural nodules are the subgroup managed conservatively with surveillance, which is the trap this stem sets against the key.

Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.