Ovary - nontumor

Topic Completed: 1 December 2011

Revised: 13 December 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Normal "histology" ovary [title]

Mohiedean Ghofrani, M.D.
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Cite this page: Ghofrani M Histology. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/ovarynontumornormalhistology.html. Accessed February 27th, 2020.
Definition / general
  • Ovaries are covered by surface epithelium (OSE), which is a modified mesothelium, also called coelomic or germinal epithelium (Reprod Biol Endocrinol 2006;4:42)
  • OSE is one layer of flat to cuboidal mesothelial type cells, which appear to actively participate in the ovulatory rupture and repair process
  • OSE is closely related to Müllerian duct lining epithelium
  • Stroma: comprises bulk of ovarian tissue; resembles fibroblasts in whorls / storiform pattern surrounded by dense reticulin network; contains luteinized stromal cells, decidual cells, smooth muscle, fat, neuroendocrine cells and endometrial stroma-like cells
  • Follicles: ~400K primordial follicles containing primary oocytes are present at birth in ovarian stroma (100K at gestational age 15 weeks, 680K at 8 months, Fertil Steril 2007;88:675)
  • Follicular decay appears to advance with increasing age (Hum Reprod 2008;23:699); prominent cystic follicles present at birth and at puberty
  • Postmenopausal ovary has thick walled medullary and hilar vessels, also granulomata and hyaline scars

    Stages of follicular development:
    • Primordial follicle: travels from yolk sac endoderm to ovary, develops into oogonia and oocytes, arrests at prophase of mitosis; neo-oogenesis may occur in adults (Endocrine 2005;26:301)
    • Maturing follicle: oocyte with surrounding granulosa cell layer; lacks reticulum; contains Call-Exner bodies (rosette-like formations with central filamentous / eosinophilic material consisting of excess basal lamina) and theca cells (within follicle are luteinized and produce sex hormones, external to follicle are very cellular)
    • Corpus luteum: 2 cm, round, yellow, lobulated structure with cystic center; has luteinized granulosa and theca cells; in pregnancy is larger, bright yellow with prominent central cavity, hyaline droplets and calcification
    • Corpus albicans: remnant of corpus luteum

  • Hilus (hilar) cells: located in ovarian medulla, rarely within ovarian stroma; located away from the hilum, round to polygonal, epithelial appearing, presumed vestigial remnant of gonad from its "ambisexual" phase
  • Produce steroids (predominantly androstenediaone); resemble Leydig cells of testis; may produce masculinizing tumors (hilus cell tumors)
  • Closely associated with large hilar veins and lymphatics and may protrude within their lumina; also associated with nerves
  • May contain Reinke crystalloids, lipid, lipochrome pigment
  • Resemble steroid cells by EM with microtubular smooth endoplasmic reticulum, mitochondria with tubular cristae
  • Hilar cells are seen in the fetal ovary but not in infancy and childhood; they reappear at puberty
  • Hilar cell hyperplasia: associated with hCG administration, pregnancy, choriocarcinoma
  • Rete ovarii: counterpart of rete testis, seen as clefts, tubules, cysts, papillae lined by epithelium, surrounded by spindle cell stroma
  • Walthard cell nests: usually microscopic cystic / solid structures with urothelial type epithelium and variable mucin seen in mesovarium, mesosalpinx and ovarian hilus
Diagrams / tables

Images hosted on other servers:

Section of the ovary

Case reports
Gross images

Images hosted on other servers:

Corpus luteum


With follicular cysts

Microscopic (histologic) images

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Primordial follicles and primary follicles

Secondary follicle

Graafian follicle

Mature follicles

Granulosa cells of
proliferating follicle
exhibit marked
mitotic activity

Normal histology:

Surface epithelium

Surface epithelial stromal proliferation

Vacuolar change within surface epithelial inclusion glands

Surface epithelial inclusion glands

Ovarian stroma

Luteinized stromal cells

Hilus cells

Rete ovarii

Walthard nest

Corpus luteum:

Of menstruation

Involuting at menstruation

Corpus luteum of pregnancy

Pregnancy related changes:

Granulosa cell proliferation: an atretic follicle
is filled with a proliferation of granulosa
cells growing in a pattern resembling
a microfollicular granulosa cell tumor

Granulosa cell proliferation: the granulosa cell layer of a cystic atretic follicle is replaced by solid tubules resembling a Sertoli cell tumor - the tubules are surrounded by a layer of theca lutein cells

Ectopic decidua: one
cell is vacuolated,
somewhat resembling
a signet ring cell

Ectopic decidua: large nodules were
present on the ovarian and peritoneal
surfaces, the cells have abundant eosinophilic
cytoplasm and central, pale, round nuclei


Mesothelial hyperplasia: present between outer surface of an ovarian serous borderline tumor (left) and vascular adhesion (right)

Mesothelial hyperplasia: mesothelial cells have abundant pale eosinophilic cytoplasm, small focus of calcification is evident

Mesothelial hyperplasia: numerous small tubular structures and cords of mesothelial cells are growing in a parallel array

Adrenocortical rest in mesosalpinx

Artifact: granulosa cells in blood vessel lumina

Postmenopausal: atrophic ovary

Postmenopausal: cortical granuloma

Infarcted appendix
epiploica attached to
ovarian surface, with
focal calcification

Nodular hilar cell proliferation

Hilus cell hyperplasia:
large nodular masses
of hilus cells are present,
one surrounding rete ovarii

Hilus cell hyperplasia: postmenopausal woman whose hilus cells have bizarre shapes and abundant eosinophilic cytoplasm, some nuclei are enlarged and hyperchromatic

Images hosted on other servers:


Primordial follicles and primary follicles

Tertiary follicle

Ruptured follicle

Atretic follicle

Normal histology:



Corpus luteum:


Positive stains
Negative stains

Corpus luteum

Corpus albicans

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