Ovary - nontumor
Nonneoplastic cysts / other
Polycystic ovary disease (PCO)

Author: Shahid Islam, M.D. (see Authors page)

Revised: 20 September 2017, last major update June 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Polycystic ovary disease [title]

Cite this page: Islam, S. Polycystic ovary disease (PCO). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/ovaryPCO.html. Accessed May 26th, 2018.
Definition / general
  • Formerly called Stein-Leventhal syndrome
  • Affects 5 - 10% of women in US; 3 - 15% women of reproductive age; most common cause of anovulatory infertility
  • Occurs during teenage and childbearing years
  • Associated with endometrial hyperplasia, well differentiated adenocarcinoma
  • Also acne, obesity, hirsutism, insulin resistance and diabetes
  • Endometrium may show metaplastic changes resembling adenoacanthoma or adenocarcinoma (Am J Surg Pathol 1982;6:223)

Two different diagnostic criteria:
  • NIH: androgen excess, oligoovulation and exclusion of other entities that cause polycystic ovaries
  • ESHRE / ASRM in Rotterdam (2 of 3 present):
    1. Oligoovulation or anovulation
    2. Excess androgen activity
    3. Polycystic ovaries present (by ultrasound) but no other endocrine disorders
Treatment (for infertility)
Gross description
  • Large ovaries (2x normal), numerous subcortical cysts (cysts may be immature follicles)
Gross images

Images hosted on PathOut server:

Enlarged ovary is
pearly white, multiple
cysts are visible
beneath the surface

Microscopic (histologic) description
  • Multiple cystic follicles covered by a dense fibrous capsule
  • Luteinization of the theca interna (hyperthecosis), few corpora lutea or corpora albicantia since anovulatory, atretic follicles simulate corporate albicantia
Microscopic (histologic) images

Images hosted on PathOut server:

Outer cortex is
collagenized with
several follicle cysts
arrayed beneath it

Prominent band of luteinized
theca cells surrounds the
cavity of an atretic follicle
(follicular hyperthecosis)

Virtual slides

Images hosted on other servers:

Polycystic ovary disease


Histopathology ovary - polycystic ovarian disease