Morphological pattern and misdiagnosis in polycystic ovarian syndrome
- Authors: Sosnova E.A.1, Gracheva T.S.1, Demura T.A.1, Krot M.A.1
-
Affiliations:
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
- Issue: Vol 9, No 3 (2022)
- Pages: 143-151
- Section: Original study articles
- URL: https://journals.rcsi.science/2313-8726/article/view/111029
- DOI: https://doi.org/10.17816/2313-8726-2022-9-3-143-151
- ID: 111029
Cite item
Abstract
INTRODUCTION: Polycystic ovarian syndrome (PCOS) is currently one of the most common diseases in women. Ovarian dysfunction (irregular menstrual cycle and anovulation), hyperandrogenism, and polycystic ovarian morphology are the most frequent manifestations of the syndrome. Its main macroscopic sign is bilateral enlargement of the ovaries with multiple cystic and atretic follicles. Moreover, an ovarian biopsy is usually performed in addition to clinical examination allowing for an accurate diagnosis and management.
AIM: In this study, we sought to analyze the morphological verification of PCOS.
MATERIALS AND METHODS: We analyzed 121 patients admitted to Moscow hospitals for surgical treatment diagnosed of PCOS by pathologists. Initially, PCOS was diagnosed at the outpatient examination. Thus, 121 women of reproductive age were included in the study after excluding tubal-peritoneal factors, male infertility factors, and menstrual dysfunction. Intraoperatively, all patients (n=121) were sampled for histological examination.
The patients were referred to different gynecological hospitals: a municipal clinical hospital (group 1, n=54), a research center (group 2, n=48) and a commercial clinic (group 3, n=19). We processed data using parametric and non-parametric me thods in the STATISTICA Base software package. Arithmetic means, standard deviations, medians, and percentiles were equally determined. Confidence intervals for the arithmetic mean were determined using on the Student-t distribution. Moreover, we determined the 95% confidence intervals to the frequencies and the significance of differences in frequencies between the groups using binomial distribution and the Chi-square test, respectively.
Some indicators exhibited significantly different distributions from the norm; therefore, non-parametric Mann-Whitney (p2) and Wilcoxon criteria were further applied. Differences were considered significant at p <0.05.
RESULTS: Histological findings in 121 (100%) women of reproductive age with a clinical diagnosis of PCOS after surgical treatment were analyzed. After primary analysis, the clinical diagnosis was not confirmed in 78 (64%) patients, and histological findings of PCOS or PCOS that could not be excluded were obtained for only 43 (36%) women. Re-examination of histological samples from these 43 women let to the identifying of two groups of patients: group 1 with a typical histological pattern of PCOS (n=6, 14%) and group 2 with the so-called PCOS-like conditions (n=37, 86%).
CONCLUSIONS: Significant differences were found between the morphological pattern of true PCOS and PCOS-like conditions. Thus, the final diagnosis should made clinically and through imaging, as well as through mandatory morphological examination of ovarian biopsy specimens after surgical treatment.
Full Text
##article.viewOnOriginalSite##About the authors
Elena A. Sosnova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Author for correspondence.
Email: sosnova-elena@inbox.ru
ORCID iD: 0000-0002-1732-6870
SPIN-code: 6313-9959
MD, Dr. Sci. (Med.), Professor
Russian Federation, 2, build. 4, B. Pirogovskaya str., Moscow, 119991Tat’yana S. Gracheva
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: gracheva_91@mail.ru
ORCID iD: 0000-0001-5102-5310
graduate student
Russian Federation, MoscowTat’yana A. Demura
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: demura-t@yandex.ru
ORCID iD: 0000-0002-6946-6146
MD, Dr. Sci. (Med.), Professor
Russian Federation, MoscowMarina A. Krot
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: masolomahina@yandex.ru
ORCID iD: 0000-0002-5852-913X
MD, Cand. Sci. (Med.), Assistant Professor
Russian Federation, MoscowReferences
- Savel’yeva GM, Sukhikh GT, Manukhin IB, editors. Gynecology. National leadership. Short Edition. Moscow: GEOTAR-Media; 2013. (In Russ).
- Gevorkyan MA, Blinov DV, Smirnova SO. Combined oral contraceptives in treatment of patients with polycystic ovary syndrome. Obstetrics, Gynecology and Reproduction. 2012;6(1):39–49. (In Russ).
- Balen AH, Conway GS, Homburg R, Legro RS. Polycystic Ovary Syndrome. A Guide to Clinical Management. London: CRC Press; 2006. 240 p. doi: 10.3109/9780203506158
- Guriev TD. Polycystic ovarian syndrome. Obstetrics, Gynecology and Reproduction. 2010;4(2):10–15. (In Russ).
- Pal’tsev MA, editor. Lectures on General Pathological Anatomy. Study Guide. Moscow: Moscow Medical Academy named after I.M. Sechenov; 2003. 254 p. (In Russ).
- Blesmanovich AE, Petrov YuA, Alekhina AG. Syndrom of polycystic ovaries: classics and contemporary nuances. Health and Education millennium. 2018;20(4):33–37. (In Russ). doi: 10.26787/nydha-2226-7425-2018-20-4-33-37
- Hughesdon PE. Morphology and morphogenesis of the Stein-Leventhal ovary and of so-called “hyperthecosis”. Obstet Gynecol Surv. 1982;37(2):59–77. doi: 10.1097/00006254-198202000-00001
- Jonard S, Robert Ya, Ardaens Y, Dewailly D. Ovarian Histology, Morphology, and Ultrasonography in the Polycystic Ovary Syndrome. Chapter 16. In: Azziz R, Nestler JE, Dewailly D, editors. Androgen Excess Disorders in Women. Contemporary Endocrinology. Totowa, NJ: Humana Press; 2007. P. 183–193. doi: 10.1007/978-1-59745-179-6_16
- Shepel’kevich AP, Barsukov AN, Mantachik MV. Modern approaches to the diagnosis and treatment of polycystic ovary syndrome. ARS MEDICA. 2012;(15):98–105. (In Russ).
Supplementary files
