Thread by @mathewleonardi

I used to be a gynaecologist.
Now I am a gynaecologist and sonologist (def: lexico.com/en/definition/…).
My perspective on many aspects of gynaecology has changed.

This is a tweetorial on OVARIAN CYSTS.

Inspired by the @iotacongress group and @isuog
doi.org/10.1046/j.1469…

1/

The term cyst has come to mean abnormality for patients and clinicians alike. This causes anxiety. In most cases, it shouldn’t. @proftombourne @GeorgeCondous

Most cysts found within/next to an ovary are normal.
Two examples: 1- follicular cysts and 2- corpus luteum cysts.

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Follicular cysts, or simply follicles, as I like to call them, develop every natural menstrual cycle. Anything that is unilocular with clear contents and <3cm should be described as a follicle. Removal of the term “cyst” diminishes unnecessary anxiety.

@GynaecologyUS

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If something with these features grows >3cm, it can be called a follicular cyst and usually resolves on its own. Sometimes these can bleed (can be painful!) and form what is called a hemorrhagic cyst, which also resolves on their own.

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Corpus luteum cysts -> corpus luteum, as I like to call them, should also develop in most natural menstrual cycles. A corpus luteum is the evolution of the follicle that ovulates. Unless trying to suppress ovulation, a corpus luteum is normal.

5/

Corpus luteum features can be a bit more varied, but the classic “ring of fire” is seen on ultrasound. These should not be described as complex ovarian cysts, but rather as a corpus luteum.

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Cysts are not simple or complex. The term "complex" is particularly offensive & not helpful to clinicians. Instead, we should follow @iotacongress terms & describe the features of the cyst. If possible, we should describe what type of cyst it is. Easy Descriptors! Link below.

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Which types of cysts can be described using the Easy Descriptors?

Formerly "complex":
1- Hemorrhagic (benign), 2- Endometrioma (benign), 3 -Dermoid (benign), 4- Malignant tumour with ascites.

Formerly "simple":
Serous cystadenoma (benign)

Now wouldn't this be helpful?

8/

For more @iotacongress resources, you can visit their website, which has all of their publications.

iotagroup.org

For Easy Descriptors and Simple Rules: doi.org/10.1016/j.ygyn…

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What about polycystic ovarian syndrome? Surprise, this wording is also… wrong. Polycystic ovaries have NO cysts. What was previously called a cyst was simply a small follicle, stuck in part of its development “arrested”.

Patients are always shocked to learn this!

10/

It may be more appropriate to call this polyfollicular ovarian syndrome. It should be made clear to patients they do not have cysts to help reduce unnecessary anxiety.

That's all, for now. This is not an exhaustive tweetorial.

Questions/comments about ovarian cysts? ⬇️

FIN