A 45-year-old woman is incidentally found to have a 3.5 cm branch duct intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas. The MRI shows mural nodules within the cyst, the main pancreatic duct is 4 mm (normal), and she has new-onset diabetes. According to the revised Fukuoka 2017 guidelines, this cyst has which worrisome features, and what action is warranted?
- A Only size >3 cm — enhanced surveillance MRI in 6 months
- B High-risk stigmata (mural nodule) plus worrisome features (size >3 cm, new-onset DM) — endoscopic ultrasound evaluation and consideration of surgery ✓
- C Worrisome features only — annual MRI surveillance is sufficient
- D No worrisome features — discharge and no follow-up
Correct answer: B. High-risk stigmata (mural nodule) plus worrisome features (size >3 cm, new-onset DM) — endoscopic ultrasound evaluation and consideration of surgery
Explanation
The revised 2017 Fukuoka criteria classify IPMN features as: high-risk stigmata (obstructive jaundice, enhancing mural nodule ≥5 mm, MPD ≥10 mm — mandate surgery) and worrisome features (cyst ≥3 cm, mural nodule <5 mm, MPD 5–9 mm, abrupt MPD calibre change, lymphadenopathy, new-onset DM). Mural nodules (even <5 mm) plus size >3 cm and new-onset DM are worrisome features warranting EUS evaluation; if high-risk features confirmed on EUS, surgery is indicated.
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.