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Ovary - nontumor

Non-neoplastic cysts/other

Polycystic ovary disease (PCO)


Reviewer: Shahid Islam, M.D., (see Reviewers page)
Revised: 5 June 2012, last major update June 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.

General
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● 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):
     (a) oligoovulation or anovulation
     (b) excess androgen activity
     (c) polycystic ovaries present (by ultrasound) but no other endocrine disorders

Treatment (for infertility)
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● Clomiphene citrate or FSH, weight loss
● Also “ovarian drilling”-puncture of small follicles with electrocautery (Hum Reprod 2002;17:2851), although effectiveness has been questioned (Cochrane Database Syst Rev 2007 Jul 18:CD001122)
● Formerly did wedge resections

Gross description
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● Large ovaries (2x normal), numerous subcortical cysts (“cysts” may be immature follicles)

Gross images
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Numerous small peripheral follicles


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

Micro description
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● 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

Micro images
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The outer cortex is collagenized with several follicle cysts arrayed beneath it


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

Virtual slides
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Polycystic ovary disease

Videos
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By WashingtonDeceit

Additional references
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Wikipedia, eMedicine #1; #2

End of Ovary - nontumor > Non-neoplastic cysts/other > Polycystic ovary disease (PCO)


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