Ovary
Tumor-like lesions
Stromal hyperplasia and hyperthecosis
Last author update: 1 May 2012
Last staff update: 19 October 2020
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PubMed Search: Stromal hyperplasia and hyperthecosis
Table of Contents
Definition / general | Epidemiology | Etiology | Clinical features | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Differential diagnosisCite this page: Ghofrani M, Islam S. Stromal hyperplasia and hyperthecosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarynontumorhyperthecosis.html. Accessed June 5th, 2023.
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
- 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
- Possibly excision
- Leuprolide if poor surgical candidate (Obstet Gynecol 2002;99:893)
Gross description
- Uniform enlargement of both ovaries
- Solid, yellow white cut surface
- May have superficial cysts
Gross images
AFIP images
Both ovaries are enlarged
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
Large nodule of
luteinized cells
is present within
the ovarian stroma
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
- Fibroma (unilateral or bilateral, cells have larger nuclei)
- Low grade endometrial stromal sarcoma (spiral arterioles and mitotic figures present)
