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Ovary-nontumor

Non-neoplastic cysts / other

Hyperthecosis


Reviewer: Mohiedean Ghofrani, M.D. (see Reviewers page)
Revised: 9 August 2011, last major update August 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Hyperplastic ovarian stroma with clusters of luteinized stromal cells

Epidemiology
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● Typically seen in the 6th to 7th decade, less common in reproductive age

Etiology
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● Luteinized stromal cells produce androgens

Clinical features
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● Similar symptoms as polycystic ovarian syndrome, but higher testosterone levels and no/fewer cysts
● Typically patients are obese with striking virilization and insulin resistance

Case reports
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● Associated with endometrial adenocarcinoma and pseudosarcomatous changes in endometrial stroma (Am J Surg Pathol 1984;8:939)
● Due to adrenal tumor (Arq Bras Endocrinol Metabol 2008;52:1184)

Treatment
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● Possibly excision
● Leuprolide if poor surgical candidate (Obstet Gynecol 2002;99:893)

Gross description
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● Uniform enlargement of both ovaries
● Solid, yellow-white cut surface
● May have superficial cysts

Gross images
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Both ovaries are enlarged; the cut surface of the left ovary is composed of firm, white tissue simulating a neoplasm (AFIP)

Micro description
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● Scattered nests of luteinized theca cells in ovarian stroma

Micro images
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Stromal cells are enlarged and pale staining


Numerous nests of vacuolated, luteinized cells are present in the ovarian stroma (AFIP)


The luteinized cells have an eosinophilic, non-vacuolated cytoplasm and regular, round nuclei with prominent nucleoli (AFIP)


A large nodule of luteinized cells is present within the ovarian stroma (nodular hyperthecosis)


The lutein cells contain abundant lipid (Oil red-O stain)

End of Ovary-nontumor > Non-neoplastic cysts / other > Hyperthecosis


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