MRI MRCP - Cyst (IPMN) - Newbie

I had my distal pancreatectomy on July 29, 2022. The tail end of the pancreas was removed along with the spleen. I was in the hospital for five days. I fully recovered from the surgery with no major complications. When the IPMN was noticed in 2021, I had an EUS performed that revealed benign, no alarming results. So, surgeon decided to scan again in a year, at which time the increase in dilatation was very noticeable. Pathology report after surgery suspected the IPMN might have been involved in the adenocarcinoma found. But, I was lucky that margins were clean, no spread. They removed 16 lymph nodes, all clean. With my stage 1 b diagnosis, I am undergoing chemo. I'm halfway through treatment, and it's not pleasant, but slogging through. I hope this information is helpful to you.

Hi, I have a 1.4 cm BD-IPMN and both my main pancreatic duct (6mm) and my common bile duct (15mm) are dilated. I recently was diagnosed with EPI. My doctor hasn’t suggested doing anything other than another EUS but I’m pretty concerned about it based on everything I have read.

How many months ago did you have your surgery? How are you feeling now? I read only a little bit about different procedures based on where the IPMNs are located. They removed part of your pancreas and your spleen?

I had a 2cm MD-IPMN from scan in 2021. Scan in 2022 showed cyst was 2.1 cm, but duct was showing signs of dilatation. So, I had distal pancreatectomy done this year. Pathology labeled me as stage 1b.

Refer to Figure 2 in the 2017 Fukuoka Guidelines link. It is a flow chart that summarizes recommended surveillance frequencies and intervention by size and characteristics.

I apologize for not looking at who you are or what you have been through earlier. I just responded without thinking. I’m sure you have much more information on this than I could possibly have.

I will read them again but what I meant was that the older guidelines I thought had said to do nothing about IPMNs if they are less than 3 but the newer 2017 guidelines if I remember correctly are saying that if a person also has dilated ducts and or other concerning symptoms then you do do something regardless of the size of the IPMNs. In some cases that could mean just yearly MRIs to follow and in some cases it might mean surgery.

Here is the link to the 2017 Fukuoka IPMN Management guidelines also available as a pdf file from the same link.
https://www.sciencedirect.com/science/article/pii/S1424390317305161

Those are existing guidelines since 2017. I’m familiar with those as I have referred to them many times. I thought you mentioned you saw newer guidelines. That’s what I am interested in seeing if they exist. As far as I recall, no newer guidelines exist. The Fukuoka guidelines are the most current issued by that working group.

I wish I could attach some links. I spent a tremendous amount of time researching IPMNs about 8 to 12 months ago and I saved a lot of the links in an email folder. When you asked me to show you where I found the newest guidelines, I came across a lot of really good info that I had forgotten about. ..

Fukuoka guidelines for IPMNs in 2017