Ovary - nontumor
Nonneoplastic cysts / other
Stromal hyperplasia and hyperthecosis


Topic Completed: 1 May 2012

Revised: 5 March 2020

Copyright: 2002-2020, PathologyOutlines.com, Inc.

PubMed Search: Stromal hyperplasia and hyperthecosis

Mohiedean Ghofrani, M.D.
Shahid Islam, M.D., Ph.D.
Page views in 2019: 3,581
Page views in 2020 to date: 1,263
Cite this page: Ghofrani M, Islam S. Stromal hyperplasia and hyperthecosis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/ovarynontumorhyperthecosis.html. Accessed March 28th, 2020.
Definition / general
  • Varying degrees of proliferation of ovarian stromal cells, potentially mimicking a neoplasm but without luteinization (stromal hyperthecosis refers to presence of luteinized cells in the stroma at a distance from the follicles)
  • Less frequently estrogenic or androgenic than stromal hyperthecosis
  • Patients may be obese, have hypertension or abnormal glucose tolerance
Epidemiology
  • Typically seen in the sixth to seventh decade, less common in reproductive age
Etiology
  • Luteinized stromal cells produce androgens
Clinical features
  • 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
Treatment
Gross description
  • Uniform enlargement of both ovaries
  • Solid, yellow white cut surface
  • May have superficial cysts
Gross images

AFIP images

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

Ill defined, pale
yellow tissue
occupies the center
of the ovary

Microscopic (histologic) description
  • Medullary or occasionally cortical clusters of densely cellular ovarian stroma with scant collagen
  • May entirely replace ovarian architecture
  • Scattered nests of luteinized theca cells in ovarian stroma
  • No mitotic figures
Microscopic (histologic) images

AFIP images

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

Luteinized cells have an eosinophilic, nonvacuolated cytoplasm and regular, round nuclei with prominent nucleoli

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

Lutein cells contain abundant lipid (oil red O stain)


Ovarian medulla and
cortex of an elderly
woman are replaced
by cellular stroma

Confluent nodules
of hyperplastic
stroma occupy
the medulla

Differential diagnosis
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