a. Pancreatitis may be an indication for surgery for relief of symptoms.
b. Differential diagnosis includes mucin. Mucin can move with change in patient position, may be dislodged on cyst lavage and does not have Doppler flow. Features of true tumor nodule include lack of mobility, presence of Doppler flow and FNA of nodules showing tumor tissue.
c. Presence of any one of the thickened walls, intraductal mucin or mural nodules is suggestive of main duct involvement. In their absence main duct involvement is incolclusive.
d. Studies from Japan suggest that on follow-up of subjects with suspected BD-IPMN there is increased incidence of pancreatic ductal adenocarcinoma unrelated to malignant transformation of the BD-IPMN(s) being followed. However, it is unclear if imaging surveillance can detect early ductal adenocarcinoma, and, if so, at what interval surveillance imaging should be performed.
