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Common Causes of Ovarian Enlargement: Miscellaneous

Other causes of ovarian enlargement include polycystic ovarian syndrome (PCOS), theca lutein, and granulosa and or theca cell tumors. Polycystic ovarian syndrome is a spectrum of related disorders which numerically is the most common cause of bilateral ovarian enlargement. This disorder is characterized by anovulation or oligoovulation, hyperandrogenemia, and often obesity.

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Hirsutism. This woman has polycystic ovarian syndrome and hyperandrogenemia resulting in hirsutism.
Credits: C. Matthew Peterson,M.D.

Increased luteinizing hormone levels (LH) are often detected. Approximately, 3-7% of the female population have this syndrome. The ovaries of affected patients have a thickened, white cortex with numerous small follicular cysts surrounding the periphery which usually measure 10 mm or less.

Polycystic ovary-pearl necklace sign
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Polycystic ovary-pearl necklace sign. Underlying the bladder is the ovary with a classical polycystic appearance often referred to as a "pearl necklace".
Credits: Paula Woodward, M.D.

Conditions with high levels of human chorionic gonadotropin (hCG) such as gestational trophoblastic neoplasia, choriocarcinoma, and occasionally in a normal pregnancy can be associated with the development of multiple theca lutein cysts.

Theca lutein cysts
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Theca lutein cysts. Normal pregnancies, gestational trophoblastic neoplasia, and choriocarcinoma may be associated with theca lutein cysts.
Credits: C. Matthew Peterson, M.D.

Microscopically the ovaries have multiple theca lutein cysts which have prominent luteinization of the thecal compartment.

Serous cystadenoma
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Serous cystadenomas. These tumors comprise 20% of all ovarian neoplasms. The epithelium is a single layer of regular cuboidal epithelium, with basal nuclei and rare mitoses.
Credits: Alan B.P. Ng

Stromal edema and luteinization may also be seen. When this condition exists in association with gestational trophoblastic neoplasia it is termed hyperreaction luteinalis.