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

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

Revised: 6 August 2018, last major update June 2012

Copyright: (c) 2002-2018, 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 November 12th, 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)


Histopathology ovary - polycystic ovarian disease