A 62-year-old man with recurrent acute pancreatitis undergoes MRI which shows diffuse segmental dilatation of the main pancreatic duct measuring 8 mm with a 6 mm enhancing mural nodule within the duct. Fine needle cytology shows no malignancy. The most appropriate management is:
- A Surgical resection of the involved pancreas ✓
- B Surveillance MRI every 6 months
- C Endoscopic cyst gastrostomy
- D Total pancreatectomy with islet autotransplantation
Correct answer: A. Surgical resection of the involved pancreas
Explanation
These findings define a main duct intraductal papillary mucinous neoplasm. Main duct involvement, absolute duct diameter above 5 mm, and any mural nodule are high-risk stigmata mandating resection regardless of cytology, because malignancy rates reach 50 to 70 percent. Surveillance applies only to branch duct lesions below high-risk thresholds. Total pancreatectomy is excessive unless the ductal change is truly diffuse and multifocal.
Reference: Schwartz's Principles of Surgery, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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