Anatomy & histology

Topic Completed: 1 December 2011

Minor changes: 5 May 2020

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

PubMed Search: Normal histology ovary

Mohiedean Ghofrani, M.D.
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Cite this page: Ghofrani M. Anatomy & histology. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/ovarynontumornormalhistology.html. Accessed June 1st, 2020.
  • Paired ovoids on either side of the uterus close to lateral pelvic wall, behind broad ligament, anterior to rectum

    Each ovary is connected:
  • Along its anterior (hilar) margin to posterior aspect of broad ligament by mesovarium (double fold of peritoneum)
  • At its medial pole to ipsilateral uterine cornu by utero-ovarian ligament
  • At superior aspect of lateral pole to lateral pelvic side wall by infundibulopelvic (suspensory) ligament

  • Premenopausal ovaries are each 3 - 5 cm long and weigh 5 - 8 g; size and weight depends on amount of follicular derivatives (cysts and corpora albicantia / lutea); shrink to about half their size after menopause
  • Neonates often have cysts, which resolve spontaneously (J Pediatr Endocrinol Metab 2007;20:397)
  • Pink white exterior is initially smooth but gradually becomes more convoluted
  • Cystic follicles and corpora lutea may be visible from outside
  • Cut section may exhibit three zones: cortex, medulla and hilus, with follicular derivatives usually in the cortex and medulla
  • Arterial supply: approximately 10 arterial branches from anastomotic arcade of ovarian artery (branch of aorta) and ovarian branch of uterine artery penetrate hilus into medulla and cortex
  • Venous drainage: left ovarian vein drains to left renal vein, right ovarian vein drains to inferior vena cava
  • Lymphatic drainage: originates predominantly from theca layer of follicles, exiting through the hilus, to the mesovarium, along the infundibulopelvic ligament, into upper paraaortic lymph nodes; may bypass to internal iliac, external iliac, common iliac, sacral, obturator, pelvic, retroperitoneal or inguinal nodes
  • Function first described by Reinier de Graaf (Arch Pathol Lab Med 2000;124:1115)
  • Ovulation: induces cyclic rupture and regenerative repair of the ovarian surface epithelium
  • 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
    AFIP images


    Images hosted on other servers:


    Section of the ovary

    Case reports
    Clinical images
    Images hosted on other servers:

    Ovary about to release an egg

    Gross images

    Images hosted on other servers:

    Corpus luteum


    With follicular cysts

    Microscopic (histologic) images

    Scroll to see all images:

    AFIP images


    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

    Positive stains
    Negative stains

    Corpus luteum

    Corpus albicans

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