Hirsutism in ovarian hyperthecosis.

Abstract

In 1935 Stein & Leventhal drew attention to the »polycystic ovarian syndrome«. Since then many authors have reported cases of this syndrome (Stein & Cohen, 1939; Leventhal, 1941; Stein, 1945; Selye, 1947; Ingersoll & McDermott, 1950; Meaker, 1950, and Shippel, 1950). Initially the symptom complex comprised only amenorrhoea and sterility. Afterwards it became evident that approximately 50 per cent of the patients showed hirsutism, while a more or less marked adiposity was also common. In 1949 Stein, Cohen & Elson, reported that meno-metrorrhagia is sometimes observed. Meaker (1950) saw 65 women with this syndrome: 30 presented amenorrhoea and sterility, 9 only amenorrhoea, 22 only sterility, one sterility and meno-metrorrhagia, 3 exclusively menometrorrhagia. Robinson (1935) observed metrorrhagia due to hyperplasia of the uterine mucosa in a case of this syndrome; this is presumably also the case in Rheuby’s (1938) patient. Holmer (1950) described the syndrome in women with regular anovulatory bleeding and Stokhuyzen (1950) found it in a patient with cyclic bleeding and a normal endometrium in the menstrual phase. The common finding in all these cases is the fact that both ovaries are enlarged. This is due to the presence, in the cortical layer, of a number of cysts ranging in diameter from 1 mm. to 1 cm. Frequently a transverse section of the ovary presents a more or less lardaceous aspect. Microscopically they show a typical picture, which we have also been able to observe. The tunica albugínea is frequently thickened (Fig. 1). There are numerous primordial follicles and other follicles in all stages of development. The cysts are follicular and present in large numbers. The granulosa cell layer of these cysts is often thin and partly shed. A striking finding in many cases is a hypertrophie theca interna, which is, moreover, usually luteinized (Figs. 2, 3, 4). The luteinization sometimes appears to continue into the surrounding theca externa, the cells of which become epitheloid (Fig. 5). Islands of luteinized cells may be present (Fig. 6) ; in serial sections, however, w7e have consistently observed a connection between these islands and a follicle. Geist & Gaines (1942) and Turner (1943) found clusters of luteinized cells, scattered in the stroma at a great distance from the follicles.