Dysfunctional ovarian cysts

Dysfunctional ovarian cysts are cysts derived from the follicular apparatus either before (follicular cysts) or after ovulation (corpus luteum cysts).

Sex cord stromal cells include the granulosa and theca cells which nuture the oocyte. Granulosa cells under FSH secrete oestrogen & theca cells under LH secrete androgens.

The oocyte is surrounded by granulosa cells (which may show call-exner bodies) and surrounded by a theca interna with plump cells and a theca externa with more spindled cells.

The formation of the corpus luteum has two phases  firstly blood vessels growing into the collapsed granulosa cell layer and then undergoes luteinisation.

Types of Dysfunctional ovarian cysts:

Follicular cysts (unleutinised) – have well preserved granulosa cells and theca cells separated by the basal lamina. Granulosa cells contain round to oval nuclei and a small rim of distinct cytoplasm.  When these involute they may shed the granulosa cells into the cyst space.

Simple cysts – when follicular cysts involute the epithelium may become attenuated with no distinguishing features.

Granulosa-lutein cyst – A leutinised follicular cyst. Granulosa layer leutinises with increased eosinophilic cytoplasm. The theca layer is relatively inconspicuous.

Theca-lutein cyst – A leutinised follicular cyst. The theca cells are leutinised. Thick lining of small granulosa cells with large leutinised theca cells beneath the basal lamina.

Corpus luteum cyst – Tend to be more haemorrhagic. Evidence of a convoluted lining. Luteinised cells. Fibrotic wall. Well defined zone of vascularisation. (DD luteinised follicular cysts & endometriotic cysts)

Corpus albicans cyst  – Cyst wall is composed of a convoluted ribbon-like band of hyalinised acelluar fibrous tissue

References:

Robboy’s. Pathology of the Female Reproductive Tract. 2nd ed.

Molavi. The practice of surgical pathology.

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