Correct Answer: E
On serial imaging, two worrisome features have developed in the pancreas cyst, i.e., an enhancing mural nodule and dilation of the main pancreatic duct. These features are high-risk stigmata, and therefore surgical resection is recommended. EUS FNA can be considered but is unlikely to change management if cytology is negative. Radiologic surveillance is not appropriate unless the patient refuses surgery.
1. Tanaka M., Fernández-del Castillo C., Adsay V., et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183-97.