Background

The ovaries are the storehouse of a woman's eggs.   Many are surprised to find that a woman is born with a set number of eggs and only a very small percentage of eggs are ever released.  After menopause, the ovaries slowly involute and atrophy.  If removed prior to menopause, estrogen hormone replacement therapy is usually given. An ovarian biopsy is uncommon but may be done for infertility evaluations.  Usually the pathologist receives the entire ovary, often attached with the uterus and cervix.  Ovarian cancer is a devastating disease and is covered in another portion of this site.

OUTLINE

Epidemiology
Disease Associations
Pathogenesis
Laboratory/Radiologic/Other Diagnostic Testing
Gross Appearance and Clinical Variants	Polycystic Ovaries
Histopathological Features and Variants
Special Stains/ Immunohistochemistry/ Electron Microscopy
Differential Diagnosis
Prognosis
Treatment
Commonly Used Terms
Internet Links

DISEASE ASSOCIATIONS	CHARACTERIZATION
ADRENOGENITAL SYNDROME
Ovarian `Tumor' of the Adrenogenital Syndrome The First Reported Case Hikmat A. Al-Ahmadie, M.D. ; Jerzy Stanek, M.D. , Ph.D. ; James Liu, M.D. ; Padma N. Mangu, M.D. ; Ted Niemann, M.D. ; Robert H. Young, M.D. From the Departments of Pathology and Laboratory Medicine (H.A.A., J.S.), and Obstetrics and Gynecology (J.L., P.N.M.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pathology (T.N.), Ohio State University Hospitals, Columbus, Ohio; and the James Homer Wright Laboratories of the Massachusetts General Hospital (R.H.Y.), Harvard Medical School, Boston, Massachusetts, U.S.A.	Am J Surg Pathol 2001;25:1443-1450 Abstract quote We report the case of a 36-year-old woman with congenital adrenal hyperplasia from 21-hydroxylase deficiency who had been receiving replacement therapy with corticosteroids since birth. At the age of 35 years, she developed abrupt aggravation of her virilizing symptoms and underwent an adrenalectomy and partial left oophorectomy. Persistent virilization and high testosterone levels led to right oophorectomy and completion left oophorectomy 6 months later. Each adnexa contained ovarian or paraovarian soft brown masses that on microscopic examination were identical to the testicular tumor of the adrenogenital syndrome. This represents the first reported case of this pathology (well known in the testis) in the ovary.

 

CLINICAL VARIANTS	CHARACTERIZATION
Polycystic Ovaries

 

HISTOPATHOLOGICAL VARIANTS	CHARACTERIZATION
CALCIFICATIONS
Calcifications in ovary and endometrium and their neoplasms. Silva EG, Deavers MT, Parlow AF, Gershenson DM, Malpica A. Departments of Pathology (EGS, AM, MTD) and Gynecologic Oncology (DMG), The University of Texas M. D. Anderson Cancer Center, Houston, Texas.	Mod Pathol 2003 Mar;16(3):219-22 Abstract quote In this study, we investigated the role of hormones in the pathogenesis of calcifications in ovary and in endometrium and their neoplasms of the gynecologic tract and assessed the anatomic location and incidence of these calcifications. The study consists of three parts designed to investigate the pathogenesis, the location, and the incidence of calcifications in ovary and endometrium and their neoplasms. In the first part, 79 female guinea pigs were divided into 10 groups, and different hormones, given weekly for 12 months, were administered to the guinea pigs by group. A control group of 7 guinea pigs received sterile water. Calcifications developed in 5 of 7 guinea pigs treated with prolactin, 10 of 20 treated with human chorionic gonadotropin, 5 of 11 treated with estradiol, 3 of 7 treated with estrone, 1 of 6 treated with growth hormone, and 1 of 10 treated with testosterone; in 20 of the guinea pigs, the calcifications developed in the stroma of the endometrium, and in 5 guinea pigs, they developed in the ovary. The second part of the study consisted of an evaluation of the specific location of calcifications in 43 consecutive human surgical ovaries and endometria. Calcifications were seen only in the stroma in 100% of the ovarian serous adenofibroma specimens; in ovarian serous borderline neoplasms, the stroma contained 70 to 100% of the calcifications, and the epithelium had 0 to 30% of the calcifications. In ovarian serous carcinoma specimens, the calcifications were seen in the stroma in 50 to 60% of the cases, in the epithelium in 40% of the cases, and in areas of necrosis in 10% of the cases. The third part of the study was directed to determine the frequency of calcifications in ovarian lesions. We found that all cases of endosalpingiosis and ovarian low-grade serous carcinoma had calcifications, whereas 80% of the cases of serous borderline tumor had calcifications, and only 50% of the cases of ovarian high-grade serous carcinoma contained calcifications. The results of this study indicate that the majority of the calcifications in the ovary and the endometrium and their neoplasms are present in the stroma. This is most probably secondary to metabolic changes, which could be related to hormones and not caused by degenerative changes in epithelial cells.

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Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Seventh Edition. WB Saunders 2005.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001. Hum Pathol 2000;31:1420-1424.

Basic Principles of Disease
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Commonly Used Terms
This is a glossary of terms often found in a pathology report.

Diagnostic Process
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Surgical Pathology Report
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Special Stains
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Last Updated March 18, 2005

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