Ovarian Hilus Research Articles

Triploidy syndrome in a liveborn female

We present the autopsy report of a liveborn triploid female, born after 36 weeks of gestation, who died at the age of 20 hours. External features were diagnostic: fetal hypoplasia, hypertelorism, microstomia, micro-and retrognathia, preauricular skin tag, low-set ears, and 3-4 syndactylia. All internal organs were hypoplastic. There were atrial and ventricular septal defects. Adrenals and kidneys were fused, the gallbladder was absent, and ovarian hilum cell were found to be hyperplastic. Triploidy, 69xxx, was confirmed cytogenetically. The placenta was hypoplastic and, microscopically, revealed a peculiar type of immaturity, so-called hydatidiform villous hypoplasia, findings which have not been previously reported. We suggest that the generalized fetal and placental hypoplasia and the severe hypoplasia of all internal organs are caused by a proliferative deficiency of the triploid cells. In addition, the nuclear DNA content was determined by cytophotometrically from placental stromal cells and was found to be about 50% above the normal diploid DNA value; i.e., a triploid DNA value was confirmed.

Neurofibroma of the ovary

We report an unusual example of ovarian neurofibroma in a woman with neurofibromatosis (von Recklinghausen's disease). The neoplasm caused ovarian enlargement which surgically simulated malignant neoplasm. Ovarian neurofibromas are extremely rare and may arise from small myelinated nerves in the ovarian hilum.

Histamine, mast cells and ovarian function.

Mast cells, endothelial cells, basophils and platelets are potential sources of histamine in the ovary. Little is known about the role of the latter three cell types in ovarian function. Several studies have revealed changes in the number and degranulation (release of histamine) of mast cells in the ovary during the cycle. Mast cells degranulate on pro-oestrus in the rodent ovary, and mast cells numbers increase in the theca externa of the dominant follicle in the bovine ovary. In rodents, mast cells are limited to the ovarian hilum and are not observed in follicles, corpora lutea and interstitium; this contrasts with larger species such as man, cows and monkeys where mast cells are observed throughout the ovary. Evidence is accumulating that mast cell degranulation in the ovary may be regulated by neuronal input. Neurones have been shown to have close morphological relationships with mast cells in the ovary. Histamine participates in regulating capillary permeability and blood flow in the ovary. These actions are induced by injections of LH, yet the mechanism by which LH induces mast cell degranulation is unknown. Histamine stimulates ovarian contractility, ovulation and follicular progesterone secretion in vitro. Whether these actions of histamine occur in vivo are currently unknown. This review gives a chronological description of the discoveries of the effects of histamine on ovarian function and makes suggestions for future research in this area.

Castration-sparing management of an adolescent with huge bilateral cystic teratomas of the ovaries

In order to avoid the castrating effect of bilateral oophorectomy in a teenager with bilateral huge ovarian teratomas, a plane of dissection was developed near each ovarian hilum, and the cysts were excised in toto without spillage. Postoperatively, menstruation resumed promptly as the hormonal levels returned to normal. Benign cystic teratomas of the ovaries can be excised without the need for oophorectomy. This ovarian-sparing technique is particularly useful in cases of bilateral teratomas, where reproductive and hormonal functions should be preserved.

Alterations in Mast Cell Degranulation and Ovarian Histamine in the Proestrous Hamster 1

Mast cells in the ovary of cyclic hamsters were observed exclusively in the hilum and in the vicinity of blood vessels that enter and exit the ovary. Ovaries were collected on proestrus from hamsters at 0900 h preluteinizing hormone (LH) surge, 1500 h (peak LH surge), and 2100 h (post-LH surge) and processed for routine histologic staining with toluidine blue. A significant increase in the percentage of extensively degranulating mast cells was observed coincident with the gonadotropin surge (0900 h: 5.39 +/- 0.97%; 1500 h: 20.39 +/- 2.76%). At the peak of the LH surge the ovarian histamine concentration was also significantly higher than those before and after the surge (1500 h: 5.13 +/- 0.94 ng/mg ovary; 0900 h and 2100 h: 2.84 +/- 0.35 and 3.02 +/- 0.48 ng/mg, respectively). The results indicate that a major source of ovarian histamine may be mast cells residing in the ovarian hilum and surrounding the ovarian blood vessels that enter and exit the ovary. In addition, the gonadotropin surge on the day of proestrus may be a trigger for release of mast cell histamine.

The fine structure of the human ovarian hilus cells.

The fine structure of the human ovarian hilus cells.

Countercurrent transfer of testosterone by the ovarian vascular pedicle of the cow: evidence for a relationship to follicular steroidogenesis.

Utilizing an in vitro perfusion procedure, the current studies were performed to determine whether [3H]T testosterone ([3H]T) is transferred from ovarian vein to artery by countercurrent penetration during Days 18–19 of the bovine estrous cycle. The possible relationship of such a transfer to follicular steroidogenesis was also examined. Infusion of [3H]T, but not 51Cr-red blood cells, into the ovarian vein 1–2 cm below the ovarian hilus resulted in the recovery of radiolabel (ⵐ4.7%:range=2–1 3%) in ovarian arterial blood of all preparations tested. We also infused [3H]T directly into the arterial circulation. During constant-rate infusion, approximately 43% of the [3H]T infused into the vein and 37% of that infused into the ovarian artery remained sequestered within the periovarian tissue-fluid complex. At the end of 30-mm experiments, a markedly higher (P<0.001; P<0.05) amount of radioactivity per ml follicular fluid (FF) was observed in the largest follicle compared to that observed in small-medium follicles. Radioactivity remaining in follicles as testosterone (T) was markedly lower (P<0.0O1) and concentrations of estriol, dihydrotestosterone! androsterone, androstanedione, estradiol-17β, androstenedione, androstanediol, and estrone were consistently higher (P<0.O01) in follicular fluid (FF), granulosa (Gr) and theca (Th) relative to concentrations in the highly purified infusate (>99.5% T). In 60-mm experiments, in which perfusion continued for 30 mm after termination of [3H]T infusion, sequestered radiolabel as T declined (P<0.001) in both follicles (17–20%) andovarian venous effluent (2–5%) relative to that present in the infusate. Coincident with this decline in ([3H]T was a marked (P<O.001) increase of all seven metabolites studied in FF, Gr and Th. All of these steroids, except androstanediol and estradiol-17β, increased (P<0.05) in ovarian venous effluent of ovaries bearing the largest follicle or small-medium follicles. Results suggest an important countercurrent concentrating mechanism for T in the ovarian vascular pedicle which provides additional substrate for follicular metabolism/aromatization.

Morphology and morphogenesis of the Stein-Leventhal ovary and of so-called "hyperthecosis".

A study of 34 full-thickness Stein-Leventhal ovarian wedges and 30 age-matched control ovaries allowed comparison of the entire ovarian cross-sections and quantification of their features. As compared with controls, Stein-Leventhal ovaries showed on average (i) double the cross-sectional area, (II) the same number of primordial follicles, (iii) double the number of ripening and subsequent atretic follicles from the earliest stages, (iv) a tunica increased by 50 per cent and more collagenized, (v) cortical stromal thickness increased by a third, (vi) subcortical stroma, whether deep cortical or medullary in site, increased five times, (vii) ovarian hilus cell nests four times as frequently. The increased subcortical stroma was derived partly from the regressive conversion into stroma of the over-numerous older follicles, so augmenting steadily with duration, and partly from a concurrent stromal hyperplasia. Stromal smooth muscle and lutein cell nests were each found in four-fifths of cases. So-called "hyperthecosis," in which such nests are combined with marked stromal increase, is arguably just a late stage of Stein-Leventhal morphology. The whole picture may result directly or indirectly from the raised LH output, although androgens possibly promote early follicle ripening.

Steroid secretion and testosterone binding in a woman with an ovarian hilus cell tumor and thyrotoxicosis

Presented is the case of a 21-year-old woman with an ovarian hilus cell tumor and thyrotoxicosis. Despite massivley elevated of serum testosterone, virilization was lacking and cyctic ovulatory menses were maintained. Hypersecretion of thyroxine and an increased circutating testosterone-estradiol binding globulin (TeBG) resulted In a level of free testosterone lower than expected, thereby perhaps accounting for the negligible androgen effect. Determinations of peripheral and ovarian venous steroids provided the first In vivo evidence for the preferred synthesis of testosterone via the AΔ5 pathway in a hilus cell tumor. (Am. J. Osstet. Gynecol. 141:535,1981.)

Rat ovarian mast cells: distribution and cyclic changes.

Numerous tissue mast cells are present in the ovarian medulla and hilus and in the oviduct of rats. In the medulla, most of these mast cells are in the connective tissue of the stroma near blood and lymphatic vessels. During proestrus, many of the medullary mast cells totally degranulate and thus are not visible histochemically; they then regranulate during estrus. In contrast, the number of stainable mast cells in the ovarian hilus and oviduct does not change during the estrous cycle. Histofluorometric methods demonstrate that mast cells in the ovarian medulla and hilus, as well as the oviduct, contain histamine. In addition, the lining of small blood vessels in the ovarian medulla contains histamine. Thus, mast cell and blood vessel histamine secretion may play a role in ovarian function.

Histopathology and ultrastructure of ovarian hilus cell tumor: Report of two cases

Two ovarian hilus cell tumors were studied. One was obtained from a virilized woman, while the other was an asymptomatic incidental finding at surgery performed because of an associated ovarian cyst. The ultrastructural findings were compared with those of the few reported cases in the literature. Comparisons were also made with normal and neoplastic testicular Leydig cells, the homologues of ovarian hilus cells. Intranuclear paracrystalline inclusions were observed in the neoplastic hilus cells of both cases. Complexly structured cytoplasmic crystals were found only in Case 1. A clue to the existence of these particular inclusions was the presence of small eosinophilic masses in corresponding locations in the histologic sections. Neither type of inclusions has been previously described. It is postulated that these and related types of structures are precursors of Reinke crystals. Actual Reinke crystals were not encountered. Prominent cytoplasmic features included vesicular smooth endoplasmic reticulum, frequent large mitochondria with tubular cristae, numerous lipid deposits, membranous whorls, lysosomes, and peroxisomes. Pigment or lipofuscin granules were not observed. Although certain ultrastructural differences existed between the two tumors, they were insufficient to explain why only the patient of Case 1 showed masculinizing effects. The overall histopathology and ultrastructure of ovarian hilus cell tumors are strikingly similar to those of testicular Leydig cell neoplasms.

The ovarian and uterine ligaments: a light- and electron-microscopic study in the rat and guinea pig.

Histological and histochemical light-microscopy techniques, supplemented by electron microscopy have been used to study the structure and autonomic innervation of the uterine and ovarian ligaments in the adult rat and guinea pig. In both species, the smooth muscle of the uterine ligament was continuous with that of the myometrium at the tubouterine junction and with the smooth muscle of the ovarian ligament. The musculature of the latter also extended into the mesosalpinx and the ovarian bursa, capsule and hilus. Using electron microscopy, smooth muscle cells of both ligaments were usually separated from their neighbours by small amounts of connective tissue, although regions of close approach between adjacent cells were frequently observed. In these areas, the plasma membranes of apposing smooth muscle cells were separated by 10–15 nm and were devoid of an intervening basal lamina. Concerning the arrangement of autonomic nerves, the smooth muscle of the uterine and ovarian ligaments in both species was not supplied by acetylcholinesterase-containing nerves. In the guinea pig, however, numerous noradrenergic nerves were observed amongst the smooth muscle cells of the uterine and ovarian ligaments, the mesosalpinx and the ovarian capsule and bursa. These findings were confirmed using the electron microscope, in which nerve terminal regions*containing characteristic small, dense-cord vesicles were encountered lying 50–100 nm from adjacent muscle cells. In contrast, the smooth muscle cells of the rat uterine and ovarian ligaments were devoid of a noradrenergic nerve supply. These results have been correlated with the observations of previous workers, and the significance of the present findings, particularly in relation to the functional activity of the adult uterine and ovarian ligaments, has been discussed.

Endometriosis. III. Complete operations: Reasons, sequelae, treatment

Among 2,454 women who had major gynecologic operations, endometriosis was found in 350. Reproductive function was preserved for 77 young patients who desired children, and ovarian hormonal function was preserved for 129 middle-aged patients. However, the remaining 144 patients (average age, 44.4 years) had uterus, adnexa, and endometriosis resected, because of deep involvement of the ovarian hilum, ureteral wall, sigmoid wall, or other tissues. Endometriosis was removed from 17 postmenopausal women; it probably produced major symptoms in 10. Clinical explanations are presented for physiologic response of this estrogen-sensitive tissue after the menopause. After resection of endometriosis, adnexa, and uterus, 96 patients received oral estrogen therapy for postoperative menopausal symptoms. Indications and contraindications for this treatment are discussed. Endometrioid adenocarcinoma was found adjacent to endometriosis in 3 patients (less than 1%).

Adrenal Cortical Rests of the Ovarian Hilus of the Patas Monkey

Adrenal Cortical Rests of the Ovarian Hilus of the Patas Monkey

Cell specific steroid inhibitions in histochemical steroid 3-beta-ol dehydrogenase activities in man.

Histochemical evidence is presented for the occurrence of specific steroid 3β-ol dehydrogenase activities in steroidogenic cells of the human ovary, testes and adrenal. The enzymes in the cells of the corpus luteum and adrenal show similar dehydrogenase reactions with some steroid substrates and are inhibited by progesterone, a known physiologic steroid. Theca cells have an activity which is less readily demonstrated and apparently inhibited by both progesterone and DHA. The ovarian hilus cells and the interstitial cells of the testis contain steroid dehydrogenase activity which is inhibited by DHA and not by progesterone. The cellular specificity suggests that the type of activity plays a major role in determining the type of hormone production. The specificity of the steroid inhibitors suggests the possibility of intracellular feedback mechanisms which control the amount of hormone produced.

Ovarian cortical stroma, a steroid-dependent tissue

The ovaries of menopausal and postmenopausal women have been considered a source of estrogens in cases of endometrial hyperplasia and carcinoma. Eighty-four ovaries, removed at operation, were studied with special attention to the ovarian cortical stroma by histologic and histochemical techniques. The findings were correlated with other available clinical and pathologic data. Ovarian cortical stromal hyperplasia, unless accompanied by thecomatosis, does not show evidence for active steroidogenesis by the criteria of the presence of lipid or by hydrolytic or oxidative enzyme reactions. Cortical stromal atrophy and increased staining reactions for collagen are seen in ovaries where low estrogen levels or low estrogen/progesterone levels are to be expected. Local elevations of estrogen levels or ratios cause proliferation of the stromal cells and decreased staining reactions for collagen. Cortical stromal hyperplasia can then be regarded as a proliferative response of the ovarian stroma in the menopausal state to noncyclic, prolonged, low-grade estrogen stimulation which may originate in unruptured follicles, ovarian hilus cells, the adrenals, or, occasionally, functioning ovarian tumors of the opposite ovary.

Ovarian hilus cells and endometrial carcinoma

Ovarian hilus cells and endometrial carcinoma

Adenocarcinoma of the endometrium following radiation therapy and associated with hilus cell hyperplasia

The case history is presented concerning a 65-yr-old woman in whom a malignant uterine tumor was found 28 yr after pelvic x irradiation for a benign condition. The estimated mid-pelvis dose was 1350 r. The endometrial adenocarcinoma was accompanied by a proliferation of ovarian hilus cells. The patient had also developed a cecal adenocarcinoma 16 yr after radiotherapy. It is suggested that x irradiation may have been-primarily responsible for both tumors and that hilar hyperplasia may have provided endocrine stimulation acting as a secondary factor in the induction of the endometrial cancer. Thus, irradiation may have acted as the initiating stimulus and excessive hormone output as the promoting factor or cocarcinogen. An extensive review is made of the literature of cases of this type. (H.H.D.)

Ovarian hilus cell (Leydig cell) hyperplasia associated with masculinization.

OVARIAN tumors which are known to produce masculinization have usually been classified as arrhenoblastomas of the ovary, adrenal-like tumors of the ovary, and luteomas. The relationship of these tumors to each other, especially as regards histogenesis, morphology, and endocrine function, is a matter of continuing discussion, but these relationships remain unsettled. Teilum1has emphasized the need for an improved histogenetic and morphologic classification of these and other functioning ovarian neoplasms. Another ovarian lesion associated with virilization, namely, hyperplasia or tumor of ovarian hilus cells, has recently been studied by Sternberg2and discussed by Schiller.3The ovarian hilus cells have been called sympathicotropic cells, ovarian Leydig cells, ovarian interstitial cells, and extraglandular Leydig cells; they are morphologically indistinguishable from testicular interstitial cells of Leydig (which produce androgen in the male) and are considered to be a possible source of ovarian androgen.2 Cases of tumor of ovarian hilus cells have been reported

Influence of chorionic gonadotropin on human ovarian hilus cells, Leydig-like cells.

THE effects of stimulation of testicular Leydig cells by chorionic gonadotropin are well known. Since the ovarian hilus cells are morphologically identical with and probably functionally related to Leydig cells, they might also be expected to respond to chorionic gonadotropin. Morphologic changes in response to such hormonal stimulation would suggest that the cells are functionally active, and not merely embryologic rudiments. Furthermore, the character of the cytologic response might xeamrm the kinship of the ovarian cells to testicular Leydig cells.