Reduction of insulin resistance after correction of nonneoplastic ovarian virilization

A 60-year-old woman with a progressive virilization for about 5 yr developed diabetes mellitus with elevated insulin levels (fasting insulinemia ranging 32.4-45.8 microU/ml). The marked increase of plasma testosterone (total 5.7-8.2 ng/ml; free 11.5 pg/ml) and other endocrine markers clearly indicated the ovarian origin of hyperandrogenism. Pelvic ultrasonography, computerized axial tomography, and direct examination of ovaries during laparotomy, showed no evidence of neoplasia. Microscopic examination and immunocytochemical investigations confirmed the diagnosis of hyperthecosis. After oophorectomy and regression of hyperandrogenism, fasting and postprandial blood glucose concentrations normalized in spite of persistently elevated levels of insulinemia (fasting values ranging 32.0-61.0 microU/ml). The present case suggests that pathological increase of testosterone can interfere with insulin-glucose balance impairing the peripheral sensitivity to insulin.

Expression of adult T-cell leukaemia-derived factor, a human thioredoxin homologue, in the human ovary throughout the menstrual cycle

An immunohistochemical study of the expression of adult T-cell leukaemia-derived factor (ADF), a human thioredoxin homologue, was performed in the normal human ovary throughout the menstrual cycle. Primordial follicles were negative for ADF. Both granulosa cells and theca interna cells at the stages of preantral and antral follicles contained ADF. The staining intensity of these cells was very strong in the preovulatory dominant follicle. After ovulation, both granulo-lutein and theca-lutein cells were positive for ADF. During pregnancy, the theca-lutein cells revealed very intense ADF staining. The theca interna cells of the atretic follicles showed ADF staining, while the granulosa cells of such follicles did not. These results suggest that ADF localizes in the ovarian steroidogenic cells which have the binding sites of either luteinizing hormone or follicle-stimulating hormone, and that ADF expression is closely associated with the activity of the ovarian steroidogenic cells.

Combined ovarian vein catheterization with ovarian stimulation in the diagnosis of androgen overproduction

A 28-year-old woman was evaluated for late onset secondary amenorrhea, progressive hirsutism and an elevated serum testosterone concentration. Her serum cortisol, androstenedione, dehydroepiandrosterone sulfate and 17-hydroxyprogesterone levels were normal. Bilateral ovarian and adrenal vein catheterization demonstrated mild elevated testosterone and androstenedione levels in the right ovarian vein. Fifteen minutes after administering the intravenous injection of 5,000 IU human chorionic gonadotropin, there was a six and a half to sevenfold increase in the level of these two hormones in the right ovarian vein with no significant change in hormone levels from other sources. Based on the ovarian peripheral vein gradients obtained during venography following ovarian stimulation, the diagnosis of right ovarian hyperthecosis was made. This diagnosis could not have been reached without the combination of selective ovarian vein catheterization and ovarian stimulation. We recommend that this combined test, which may provide additional information on the source of the androgens in women with hyperandrogens, be performed in selected cases, when a virilizing tumor is suspected.

[Postmenopausal virilization in thecosis of the ovaries]

We describe the case of a 74-year-old woman with a fifteen-year old history of virilism and with a Type-II-diabetes mellitus treated with insulin. After the removal of the ovaries, the formerly elevated serum-testosterone levels normalised and the signs of virilism gradually abated. The histological finding of stromal thecosis in the ovaries is discussed in relation to hyperinsulinaemia and other potential stimuli for ovarian stromal hyperplasia.

Thecal and interstitial cells in polycystic ovaries (PCO) in the rat

Two different types of experimentally-induced polycystic ovaries (PCO) have been examined. A macrocystic ovarian condition is induced by estradiol valerate (EV) injection, whereas a microcystic ovarian condition is engendered with subcutaneous estradiol implants. In both of these models thecal and secondary interstitial cells were characterized using three functionally significant indices. Expression of alkaline phosphatase was evaluated immunohistochemically, hCG/LH-binding capacity was assessed by means of EM radioautography, and the size and percent cytoplasmic area of intracytoplasmic lipid were determined, in the same cells, by morphometry. In both types of ovary, thecal cells of healthy and atretic follicles stained heavily for alkaline phosphatase whereas cystic theca exhibited little or no staining. Intermittent faintly stained patches of secondary interstitial cells, as well as intensely stained spheroidal cell clusters, were most numerous in the microcystic ovary and occurred less frequently in the macrocystic ovary. Cystic thecal cells in both conditions exhibited large lipid droplets and minimal hCG binding. Lipid droplet area was minimal and hCG binding maximal in secondary interstitial cells of both types of ovary. It is concluded that specific clusters of secondary interstitial cells are important steroidogenic elements in PCO, whereas cystic theca is relatively inert.

Virilization in a postmenopausal woman due to ovarian stromal hyperthecosis

Virilization in women is occasionally caused by ovarian stromal hyperthecosis. Although three cases of post-menopausal women with hyperthecosis have been reported, the history in two of them strongly suggests a premenopausal origin. We describe a 64 year old woman with postmenopausal virilization due to bilateral ovarian stromal hyperthecosis.

Specific binding sites for insulin-like growth factor I in the ovarian stroma of women with polycystic ovarian disease and stromal hyperthecosis

Women with polycystic ovarian disease and hyperthecosis have hyperinsulinemia and insulin resistance. It is possible that insulin in supraphysiologic concentration exerts its steroidogenic action on ovarian stromal cells through insulin-like growth factor I receptors. We undertook this study to investigate whether the ovarian stroma of women with hyperthecosis has specific binding sites for insulin or insulin-like growth factor I. Ovarian stromal tissue was obtained from seven women with normal ovulatory cycles and from five women with hyperthecosis of the ovaries. Binding studies with insulin tagged with iodine 125 and insulin-like growth factor I tagged with iodine 125 revealed specific binding sites both for insulin and insulin-like growth factor I in the ovarian stroma. The binding of insulin tagged with iodine 125 in the ovarian stroma of women with hyperthecosis (3.4% +/- 1.1% (+/- SE) per 100 micrograms protein) was significantly (p less than 0.04) lower than that observed in normal premenopausal women (8.3% +/- 1.6% per 100 micrograms protein). By contrast, the specific binding of insulin-like growth factor I tagged with iodine 125 in the ovarian stroma of women with hyperthecosis (7.1% +/- 1.7% per 100 micrograms protein) was higher than that observed in the ovarian stroma from normal women (4.5% +/- 1.7% per 100 micrograms protein), although the difference was not statistically significant. The affinity constants for these high-affinity receptors were similar (1.2 to 3.6 x 10(9) L/mol) in the two groups of women. These results indicate that (1) the ovarian stroma has specific binding sites both for insulin and for insulin-like growth factor I; (2) in women with hyperthecosis, the ovarian stroma has decreased binding sites for insulin but has normal concentrations of insulin-like growth factor I receptors; and (3) in women with hyperthecosis, stimulation of ovarian androgen synthesis by insulin may be mediated through the insulin-like growth factor I receptors.

Ovarian granulosa cell tumorigenesis in SWR-derived F1 hybrid mice: preneoplastic follicular abnormality and malignant disease progression

A high incidence (27.5%; 174 of 633) of spontaneous, malignant ovarian granulosa cell tumors develop in (SWR x SWXJ-9)F1 hybrid females between 3 and 6 weeks. Granulosa cell tumors developed in predictable stages, starting as preneoplastic lesions appearing as hyperemic follicles on the ovarian surface. These follicles were characterized by hypertrophied theca, degenerating oocytes, and large fluid- or erythrocyte-filled antra lined by irregular masses of granulosa cells. Rapidly proliferating granulosa cells filled the antra and the theca/interstitial cells became more dysplastic as granulosa cell tumors developed. Thus the morphology of the preneoplastic lesion suggests that disturbed mechanisms for normal follicular development underlie granulosa cell tumor initiation. Estradiol treatment before but not after preneoplastic lesions appeared inhibited granulosa cell tumor formation. By 6 to 9 months 42% of these mice show metastases in major abdominal and thoracic organs. Thus this model can be experimentally analyzed both for mechanisms of granulosa cell tumor initiation and subsequent malignant progression.

Hyperreactio luteinalis in normal singleton pregnancy

A case of hyperreactio luteinalis in a patient with normal singleton pregnancy is reported. The course of pregnancy had been normal until the 24th week of gestation, when the mother developed lower abdominal pain and signs of virilization. She delivered of a normal female infant at 39 weeks' gestation. The baby did not show any signs of masculinization. Serum testosterone, delta 4-androstene-dione, and 5 alpha-dihydrotestosterone of the mother were markedly elevated. They remained high after the delivery but returned to the normal ranges soon after the partial resection of the enlarged ovaries. Reported causes of hyperreactio luteinalis are reviewed. Their maternal serum androgen levels were compared with cases of luteoma of pregnancy.

Steroidogenesis in human polycystic ovary

Polycystic ovarian disease (PCOD) is a heterogenous condition with a broad clinical and pathologic spectrum that may reflect the effects of diverse etiologic factors. Depending on the diagnostic data available from patients, various steroidogenic enzyme blocks have been postulated, mostly implicating higher-than-normal production of circulating delta 4-androstenedione, testosterone, and, in some cases, dehydroisoandrosterone. These high levels of androgens, because of their peripheral conversion to estrogens, lead to inappropriate secretion of gonadotropins in PCOD. Whatever may be the etiologic factors, the common entity is a polycystic ovary. Such an ovary contains preantral follicles, few antral follicles, many atretic follicles, and follicular and degenerative cysts. The follicles lack a sufficient number of mature granulosa cells to produce enough estrogens. On the other hand, there is a hypertrophy of stromal and thecal tissue continuously producing androgens. The steroid analysis of the follicular fluid obtained from the cystic follicles of the polycystic ovary revealed high concentration of delta 4-androstenedione and absence of, or only minute amounts of, estrogens. Early studies of biosynthesis of steroids in the polycystic ovary demonstrated conversion of progesterone mainly to androgens. Arising from these observations was the suggestion that an aromatase enzyme block existed. That suggestion was corroborated in the findings of higher-than-normal circulating androgens in PCOD. Later, other partial enzymatic blocks of beta-hydroxydehydrogenase and 17-hydroxylase were also suggested. However, it is known that the therapies such as wedge resection, administration of FSH, or FSH/LH (Pergonal) and LHRH leads to ovulation and, in most cases, normal cyclicity in the polycystic ovary. The knowledge gained from these therapies clearly indicates that the enzymatic blocks or abnormal steroidogenesis in the polycystic ovary may be due to the absence of proper gonadotropin response, and the main defect may be at the hypothalamic-pituitary axis. In PCOD with hyperinsulinemia, insulin and IGF-I have been implicated in the production of androgens by the polycystic ovary. The mechanism of the action of insulin or IGF-I is not yet known, however.

Fine needle aspiration cytology of a recurrent juvenile granulosa cell tumor

Fine needle aspiration biopsy was performed on a recurrent juvenile granulosa cell tumor of the ovary in a 24-year-old woman. The cytologic appearances and the results of histochemical, immunocytochemical and ultrastructural studies are described, and the differential diagnosis with other ovarian tumors is discussed.

Ovarian hyperthecosis associated with fatty liver disease

Both cirrhosis and chronic active hepatitis have been reported in patients having ovarian hyperthecosis. This case report now documents histologically verified coincidental fatty liver disease along with ovarian hyperthecosis in a patient having an 8-year evolution of abnormal liver tests, hirsutism, and irregular menses.

Treatment of severe androgen excess due to ovarian hyperthecosis with a long-acting gonadotropin-releasing hormone agonist

A 31-year-old nulligravid patient presented with irregular menses, severe hirsutism, and infertility. Evaluation revealed marked increases of serum androstenedione and testosterone levels and a possible ovarian mass. At operation a cystic teratoma was removed from the left ovary and bilateral wedge resection revealed severe ovarian hyperthecosis. After operation only a transient decrease of androstenedione and testosterone was noted and the patient failed to ovulate or improve clinically. Subsequently a long-acting gonadotropin-releasing hormone agonist was administered daily for 6 months, which reduced circulating delta 4-steroids and estrogens to levels approximating those of castrated women. Immediately after discontinuation of treatment, ovulation induction was successfully achieved with human menopausal gonadotropin. This report introduces a new therapeutic approach to the problem of severe ovarian hyperthecosis and may provide an opportunity for childbearing in these patients.

Elevated concentrations of the beta-subunit of human chorionic gonadotropin and testosterone in the amniotic fluid of gestations of diabetic mothers

Hyperplasia of testicular Leydig cells and ovarian theca-lutein cells is a common histologic finding in infants of diabetic mothers. The functional correlates of this histologic finding were investigated by measurement of the beta-subunit of human chorionic gonadotropin, testosterone, dihydrotestosterone, androstenedione, estradiol, and estrone in the amniotic fluid compartment of gestations with male and female fetuses in diabetic mothers (N = 34) and control women (N = 34) at term. When compared with those of control subjects, gestations of diabetic mothers had significantly higher amniotic fluid concentrations of the beta-subunit of human chorionic gonadotropin. Gestations with either male or female fetuses in diabetic mothers had significantly higher amniotic fluid testosterone and dihydrotestosterone levels when compared with those of their respective gender controls. In gestations with male fetuses in diabetic mothers there was a significant positive correlation between the beta-subunit of human chorionic gonadotropin and testosterone. There was no significant difference in amniotic fluid androstenedione, estradiol, or estrone levels between the gestations of diabetic mothers and those of control women. These results suggest that the testicular Leydig cell and ovarian theca-lutein cell hyperplasia seen in infants of diabetic mothers is due, in part, to elevated levels of human chorionic gonadotropin and is associated with elevated testosterone and dihydrotestosterone concentrations in the amniotic fluid.

Endocrine studies in a pregnancy complicated by ovarian theca lutein cysts and hyperreactio luteinalis

Severe virilization developed in a pregnant woman in association with the occurrence of theca lutein cysts and hyperreactio luteinalis of the ovaries. At term, maternal serum levels of androstenedione (58 ng/mL) and testosterone (20 ng/mL) were elevated massively; estrone (24 ng/mL) and estradiol-17 beta (23 ng/mL) levels were increased moderately. Maternal serum levels of human chorionic gonadotropin (hCG) just before delivery, 22,276 mlU/mL, though twice the mean for normal women at term, were within the normal range. The levels of androstenedione (1.06 ng/mL) and testosterone (0.26 ng/mL) in umbilical cord serum of her normal newborn female infant were normal. The levels of androstenedione and testosterone in serum of this woman declined slowly, but progressively, during the first two months after delivery; the serum levels of androstenedione and testosterone increased substantially, however, after she was treated with hCG eight weeks postpartum. These results are suggestive that, for reasons unknown, markedly increased androgen production with theca lutein cysts and hyperreactio luteinalis in some pregnant women results ultimately because of increased ovarian sensitivity to hCG.

The effects of long-term androgen treatment on the ovary

Ten patients with female gender dysphoria were treated with exogenous androgen (testosterone [T] enanthate USP) and underwent sex reassignment surgery. Histologic changes of the ovaries of this treated group were studied and compared with those of patients with polycystic ovarian syndrome (PCO) and a normal control group. Significant differences among groups were observed for thickness of the tunica albuginea (639.8 +/- 56.5 micron, 529.2 +/- 59.3 micron, and 170.1 +/- 29.8 micron in the exogenous androgens, PCO, and normal groups, respectively), basal membrane thickness (72.8 +/- 2.8 micron, 46.2 +/- 4.2 micron, and 25.2 micron), number of cystic follicles (2.0 +/- 0.4, 5.8 +/- 0.7, and 1.8 +/- 0.8), and T and luteinizing hormone concentrations. Theca cell hyperplasia was present only in the PCO group. It is concluded that exogenous androgen can thicken the tunica albuginea and basal membrane and that these histologic changes are similar to those seen in PCO ovaries under excess endogenous androgen production.

Hyperinsulinemia in hyperthecosis of the ovaries

Fasting insulin concentrations and the insulin response to an oral glucose tolerance test were measured in six virilized women with ovarian hyperthecosis and six weight-matched normal women. For comparison, six women with polycystic ovarian disease were also studied. The diagnosis of hyperthecosis was confirmed in all six virilized women by histologic examination of the ovaries. The fasting insulin concentrations were increased in all of the hyperthecosis patients (84 +/- 32 microU/ml). Insulin response to an oral glucose tolerance test was greatly increased (p less than 0.01) in comparison to normal women and women with polycystic ovarian disease. Significant positive correlations were found between peripheral insulin concentrations and ovarian vein testosterone (r = 0.879, p less than 0.02), dihydrotestosterone (r = 0.866, p less than 0.03), and androstenedione (r = 0.992, p less than 0.01) levels. Insulin resistance persisted after removal of the ovaries even though androgen levels returned to normal. These results suggest that a significant degree of insulin resistance exists in women with hyperthecosis and that insulin stimulates ovarian stromal androgen synthesis and thus may play a role in the pathogenesis of ovarian hyperthecosis.

Virilization during pregnancy due to bilateral hyperthecosis. A case report

A case of recurrent maternal virilization associated with bilateral hyperthecosis of the ovary during two pregnancies is described. In the first pregnancy, serum testosterone increased to the level of 12.5 nmol/l and in the second pregnancy to 35 nmol/l and after delivery to 66 nmol/l.5 months after the second birth the testosterone level was 2.7 nmol/l and virilization had spontaneously regressed. Puerperal stimulation tests with human menopausal or with human chorionic gonadotropin did not increase ovarian androgen production. Female babies were not virilized.

Juvenile granulosa cell tumor of the ovary. A clinicopathological analysis of 125 cases

The clinical and pathological features of 125 juvenile granulosa cell tumors of the ovary were analyzed. The patients ranged in age from newborn to 67 years (average 13 years). Forty-four percent were 10 years of age or younger, 34% between 11 and 20 years, 18% between 21 and 30 years, and 3% over 30 years of age. Eighty-two percent of the prepubertal patients presented because of isosexual pseudoprecocity. In the remainder of the children and in most of the older patients, the presenting manifestation was usually abdominal pain or swelling. Fifteen patients in the reproductive age group had menstrual irregularities or amenorrhea, and one of the two postmenopausal women presented with uterine bleeding. Two patients had Ollier's disease and two had Maffucci's syndrome. Laparotomy revealed unilateral involvement in 122 cases and involvement of both ovaries in two cases; bilateral tumors were found at autopsy in one case. Two tumors were Stage IIb and one Stage IIc; the remainder were Stage I. In 13 cases (11%), rupture had occurred before or during operation and ascites was present in 11 cases (9%). The tumors ranged from 3 to 32 cm in diameter (average 12.5 cm). Forty-nine percent of them were solid and cystic, 37% solid, and 14% cystic. Microscopic examination disclosed diffuse and follicular patterns, with the former predominating in most of the cases. The follicles varied in size and shape and characteristically contained basophilic or eosinophilic secretion, which often stained positively for mucin. The granulosa cells were typically luteinized to varying degrees and had dark round nuclei without grooves; a theca cell component of variable extent was present in many of the cases. The mitotic rate ranged from less than 1 to 32/10 high-power fields, with an average of 7. Nuclear atypicality varied from Grade 1 to 4. Follow-up information of at least 1 year's and up to 21 years' (average 5 years') duration was available for 95 patients, 87 of whom (92%) were alive and free of disease. One patient with Maffucci's syndrome died of chondrosarcoma 11 years after removal of the ovarian tumor (corrected survival--93%). The seven remaining patients died as a result of their tumor from 7 months to 3 years postoperatively; one of the clinically malignant tumors was Stage Iai, one Stage Iaii, two Stage Ic, two Stage IIb, and one Stage IIc.(ABSTRACT TRUNCATED AT 400 WORDS)

Massive edema of the ovary associated with hydrothorax and ascites

A 29-year-old woman with massive edema of the ovary which was grossly mistaken for neoplasia because it was associated with large volumes of both pleural effusion and ascites is described. The ovarian mass measured 10 X 10 X 8 cm and weighed 850 g. Total hysterectomy and bilateral salpingo-oophorectomy were performed. Microscopically, the ovary consisted of diffusely edematous stroma enveloping nests of hyperplastic theca cells or showing a loose myxomatous contexture. However, no endocrine activity of the ovary was demonstrated on the basis of laboratory endocrine values obtained by radioimmunoassay techniques.

Theca lutein ovarian cyst may be pathognomonic for trophoblastic neoplasia

Two cases are presented in which theca lutein tissue was found at the time of indicated pelvic surgery performed long after treatment for hydatidiform mole. This indicator for the presence of trophoblastic tissue was not recognized, and clinical metastatic gestational trophoblastic neoplasia subsequently developed in each patient. Theca lutein tissue found at pelvic surgery merits investigation by beta-human chorionic gonadotropin radioimmunoassay and is likely to be associated with subclinical latent trophoblastic neoplasia.

Ovarian hilar cells and testicular Leydig cells in anencephaly

The presence of ovarian hilar cells in anencephaly has been investigated and compared with the presence of testicular Leydig cells in the same condition. The examination of 29 anencephalic ovaries and 49 controls showed that up to 36 weeks of gestation there was a preponderance of ovarian hilar cells in anencephalic monsters as compared with controls. Similar observations were made with regard to ovarian follicles which showed more pronounced maturational changes than controls. However, during the last month of gestation both these processes were more marked in the controls. These findings are in marked contrast to our previous observations on the testes in anencephalic monsters which showed significantly less Leydig cells than controls throughout the third trimester of pregnancy. It is assumed that these appearances are due to the fact that testes and ovaries are not strictly comparable structures and may, therefore, react in a different way to hormonal stimulation. This is of particular interest as the placental chorionic gonadotrophin levels which stimulate the development of testicular Leydig cells and, supposedly, the development of ovarian hilar cells are normal in anencephaly.

Long-standing virilism in a woman with hyperplasia and neoplasia of ovarian lipidic cells

A woman with bilateral hyperplasia of ovarian hilar cells, stromal lipidic cells (hyperthecosis), and unilateral adenoma of Leydig cells is described. Her clinical course was characterized by long-standing virilism with a recent exacerbation suggesting growth of a tumor from the hyperplastic stromal lipidic cells. Evidence for this hypothesis included similar light and electron microscopic features of the hyperplastic and neoplastic cells and identical patterns of secretion of steroid hormones. Comparison of the in vivo steroid biosynthesis of the hyperplastic lipidic cells with that of testicular Leydig cells showed several similarities. These included 1) secretion of 5 and delta 4 steroids; 2) greater secretion of the delta 4 hormones, progesterone and 17-hydroxyprogesterone, than of the delta 5 steroids, pregnenolone and 17-hydroxypregnenolone; 3) prominent secretion of testosterone but not androstenedione; and 4) limited secretion of estrogens, with estradiol as the principal estrogen. These findings support prior microscopic evidence that ovarian lipidic cells and testicular Leydig cells represent cells of common function and, likely, common origin.

Hyperthecosis of the ovaries in acromegaly

Clinical and endocrine features of a patient with ovarian hyperthecosis and a growth hormone-secreting pituitary tumor are reported. A 36-year-old nulliparous woman had a history of severe hirsutism and virilization of long duration. Ovarian catheterization studies at surgery confirmed an ovarian source of excessive androgen production. Ovarian pathology revealed stromal hyperthecosis. Growth hormone levels were elevated and could not be suppressed with glucose ingestion; a pneumoencephalogram revealed the presence of a pituitary tumor. The possible cause-and-effect relationship of these 2 relatively uncommon disorders is discussed.

Estrogenization in women with postmenopausal ovarian hyperthecosis

The cases of two women who show postmenopausal bleeding and signs of endogenous estrogen production are presented. At laparotomy, ovarian hyperthecosis was found and confirmed histologically. Determination of 17 beta-estradiol concentrations in ovarian and peripheral veins suggested that these ovaries actively secreted excessive estrogens. Ovarian hyperthecosis is discussed as a cause of renewed endogenous estrogen activity in the postmenopausal women.

Ovaries and adrenals in murine Schistosomiasis mansoni. I. Histopathological changes of the ovaries in acute and chronic infection

Acute and chronic infections with schistosomiasis mansoni in mice were found to cause a reduction of the ovarian weight and atrophy of the corpus luteum cells, followed by lymphocytic and stroma cell infiltration. Finally, the corpora lutea disappeared completely. Acute schistosomiasis caused arrested development of the corpora lutea. Both acute and chronic schistosomiasis led to the formation of "wheel cells" in the interstitial tissue of the ovaries. A threshold level of intensity of disease was found to be necessary for these pathological changes. With less severe schistosomiasis, the morphology of the corpora lutea remained normal. The more intensive and long-lasting the infection, the greater became the atrophy of corpora lutea. The various factors which could have caused these pathological alterations are discussed in the light of available literature, and it is suggested that a pituitary hypofunction, and particularly a lack of luteinizing hormone effect, may play a role in the pathological transformation of the ovarian tissue.

Congenital absence of the uterus. Clinicopathologic and endocrine findings

Laparoscopic ovarian biopsies performed on 11 patients with congenital absence of the uterus revealed the presence of follicles at different stages of development, with corpora lutea in 2 patients and cystic follicles in 1 patient who had cyclic patterns of serum gonadotropins and plasma progesterone.

Histological examination of ovaries and uteri from cows with cystic ovaries

Sections were cut from 486 cysts taken from 260 pairs of cystic ovaries which had been collected during an abattoir survey. The linine of the cysts was examined for the presence of granulosa, basement membrane, theca and luteinisation. Sections of the uteri were examined and the nature of the surface epithelium, the thickness of the endometrium and the activity of the uterine glands were recorded. In those cysts associated with a corpus luteum both granulosa and luteinisation were seen less often than in other cysts. Of the 486 cysts examined 111 (22-84 per cent) had luteinisation, the others had none. Luteinisation was most often encountered when granulosa was absent. The thickness of theca was greater in cysts than in normal follicles and was thickest in thick walled cysts associated with a corpus luteum. The majority of uteri (81-9 per cent) were normal and only in 4-78 per cent was "swiss chese" dilation of the glands seen. Thirteen cases of mucometra were seen and these are discussed in detail.

Vaginal adenosis and polycystic ovaries during infancy and childhood

A histologic study of 40 postmoretem specimens of vagina, uterus, and ovaries obtained from fetuses, infants, and children revealed vaginal or ectocervical adenosis in eight cases (20.0%) and polycystic ovaries in 13 cases (32.5%). All cases of adenosis were associated with polycystic ovaries and moderate to marked theca luteinization. Five patients who had adenosis died of diseases of the central nervous system (CNS) such as cerebral injury and hydrocephalus. A total of seven of 13 cases or 53.8% with polycystic ovaries had CNS diseases. The possible roles of neurogenic and hormonal factors in the pathogenesis of these conditions are discussed.

Ovarian thecal metaplasia in adrenal glands

Wedge-shaped microscopic nodules resembling ovarian stroma or theca were found in the adrenal cortices of 14 women. Thirteen of the women were postmenopausal and one had ovarian stromal hyperplasia. The lesions were frequently multiple and bilateral and were almost always located just beneath the adrenal capsule. These nodules probably represent metaplasia of embryologically competent cells in the adrenal cortex or capsule which become transformed into ovarian tissue under the influence of unopposed pituitary gonadotropin during or after menopause. Support for this theory is found in (1) studies of human embryos that demonstrate the intimate anatomic development of ovary and adrenal gland, (2) experimental studies of mice that had morphologically similar, functional adrenal nodules following bilateral oophorectomy at birth, and (3) reports of certain human adrenal tumors. It is not known whether these nodules have functional significance in the human female.

An unusual theca lutein cyst. Report of a case

An unusual cyst lined by spontaneously lutenized theca cells--which appears to be the first reported in an adult female--is presented. It is postulated that its formation was due to an abnormal end-organ response and that the progesterone produced by it caused amenorrhea. It is suggested that theca lutein cysts may have two origins--an increased quantity of chorionic gonadotropin or end-organ hypersensitivity. When a unilateral, unilocular theca lutein cyst is found, the presence of associated trophoblastic disease can be ruled out.