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Ovary - nontumor

Non-neoplastic cysts/other

Polycystic ovary disease (PCO)

Reviewer: Shahid Islam, M.D., (see Reviewers page)
Revised: 5 June 2012, last major update June 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.


● Formerly called Stein-Leventhal syndrome
● Affects 5-10% of women in US; 3-15% women of reproductive age; most common cause of anovulatory infertility
● Occurs during teenage and childbearing years
● Associated with endometrial hyperplasia, well differentiated adenocarcinoma
● Also acne, obesity, hirsutism, insulin resistance and diabetes
● Endometrium may show metaplastic changes resembling adenoacanthoma or adenocarcinoma (Am J Surg Pathol 1982;6:223)

Two different diagnostic criteria:
NIH: androgen excess, oligoovulation and exclusion of other entities that cause polycystic ovaries
ESHRE/ASRM in Rotterdam: (2 of 3 present):
     (a) oligoovulation or anovulation
     (b) excess androgen activity
     (c) polycystic ovaries present (by ultrasound) but no other endocrine disorders

Treatment (for infertility)

● Clomiphene citrate or FSH, weight loss
● Also “ovarian drilling”-puncture of small follicles with electrocautery (Hum Reprod 2002;17:2851), although effectiveness has been questioned (Cochrane Database Syst Rev 2007 Jul 18:CD001122)
● Formerly did wedge resections

Gross description

● Large ovaries (2x normal), numerous subcortical cysts (“cysts” may be immature follicles)

Gross images

Numerous small peripheral follicles

The enlarged ovary is pearly white, multiple cysts are visible beneath the surface

Micro description

● Multiple cystic follicles covered by a dense fibrous capsule
● Luteinization of the theca interna (hyperthecosis), few corpora lutea or corpora albicantia since anovulatory, atretic follicles simulate corporate albicantia

Micro images

The outer cortex is collagenized with several follicle cysts arrayed beneath it

A prominent band of luteinized theca cells surrounds the cavity of an atretic follicle (follicular hyperthecosis)

Virtual slides

Polycystic ovary disease


By WashingtonDeceit

Additional references

Wikipedia, eMedicine #1; #2

End of Ovary - nontumor > Non-neoplastic cysts/other > Polycystic ovary disease (PCO)

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