Other nonneoplastic

Stromal hyperplasia and hyperthecosis

Topic Completed: 1 May 2012

Minor changes: 19 October 2020

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PubMed Search: Stromal hyperplasia and hyperthecosis

Mohiedean Ghofrani, M.D.
Shahid Islam, M.D., Ph.D.
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Cite this page: Ghofrani M, Islam S. Stromal hyperplasia and hyperthecosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarynontumorhyperthecosis.html. Accessed October 16th, 2021.
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
  • Typically seen in the sixth to seventh decade, less common in reproductive age
  • 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
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,

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
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