The imaging features are those of multiple side-branch IPMNs. No main ductal involvement. Branch duct type of intraductal papillary neoplasms (IPMN) appear as small cystic lesions with a bunch of grapes appearance. The key to the diagnosis is to recognize a communication with the main duct. The only worrisome feature, in this case, is the largest cyst measuring >3 cm. No other high-risk stigmata.
Multifocal IPMN has increased risk of malignant transformation. Imaging features suggestive of that include:
Case courtesy, Prof. Dr. Mohamed Eid, Professor of Radiology, Alexandria University, Egypt.