Non-Neoplastic Disease of the Ovary

David Stanford, M.D.

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I. Infection
Common bacterial infections occur in association with salpingitis and the form of tubo-ovarian
abscesses. IUD-associated pelvic actinomycosis can involve the ovary.
II. Cysts of Follicular Derivation
A. Follicular cysts occur most commonly soon after menarche or around the time of menopause. May
be incidental findings or palpable masses. Many show disturbances related to increased estrogen
production. Solitary thin-walled cysts up to 8 cm lined by inner layer of granulosa cells and outer
layer of theca cells.
B. Corpus luteum cysts occur in reproductive age group. Rarely may present with rupture and
hemoperitoneum. Solitary cyst containing blood with yellow convoluted wall lined by large
luteinized granulosa cells.
III. Hyperreactio Luteinalis
A. Bilateral multiple luteinized cysts up to 26 cm associated with pregnancy disorders associated with
high HCG such as H. mole, multiple gestations, hydrops fetalis. Incidental finding or symptoms
related to torsion, intra-abdominal bleeding and ascites.
IV. Polycystic Ovaries, Stomal Hyperplasia and Stromal Hyperthecosis
Overlapping syndromes associated with androgen excess, estrogenic manifestations, or both.
A. PCO (Stein-Leventhal): 3rd decade, oligomenorrhea, hirsutism. Bilateral ovarian enlargement.
Thick white cortex with cystic follicles lined by non-luteinized d granulosa cells. No corpora lutea
or albicans.
B. Stromal hyperplasia and hyperthecosis: post-menopausal, estrogenic manifestations
such as endometrial hyperplasia/carcinoma. HAIR-AN syndrome. Bilateral ovarian
enlargement (up to 8 cm) with white to yellow cut surface. Hyperplasia of cortical-
medullary stroma with scattered luteinized cells
V. Massive Edema and Fibromatosis
A. Massive ovarian edema occurs in young women who present with unilateral ovarian enlargement,
abdominal pain, menstrual irregularities and androgen excess. Often have torsion. Ovary enlarged
(5-35 era). Stromal edema surrounding existing follicles. Scattered luteinized cells.
B. Fibromatosis shows similar clinical features but histologically shows acellular proliferation of
spindled cells in a collagenized stroma surrounding existing follicles.
VI. Pregnancy Luteoma
A. 3rd and 4th decade, black multiparous females with bilateral ovarian nodules discovered during
C-section/tubal ligation. 25% of women and up to 2/3 of female newborns show hirsutism. Multiple,
bilateral brown nodules composed of luteinized cells with abundant pink cytoplasm.
B. Nodules regress following pregnancy.