7 - The ovary

Summary

Inflammation

NON-INFECTIVE INFLAMMATION

Non-infective inflammation is not common but may occur as a response to bleeding from endometriotic foci. It is also seen in ovaries that have undergone torsion. A granulomatous inflammatory response may occur owing to starch granules from surgical gloves, keratin derived from ruptured mature cystic teratomas or hysterosalpingographic contrast material (Figure 7.1).

INFECTIVE INFLAMMATION

Most infections of the ovary are non-specific in nature and polymicrobial in origin. Infection may be caused by blood-borne infection from remote foci. In the acute phase, the ovary is reddened and oedematous. A polymorphonuclear infiltrate is present in the superficial cortex and there may be a fibrinous exudate on the ovarian surface (Figure 7.2). It is rare for infection to extend deeply into the ovary but when it does there may be abscess formation (Figure 7.3). The chronic phase is characterised by fibrosis of the ovarian surface epithelium and the formation of periovarian adhesions (Figure 7.4).

Non-neoplastic cysts

Non-neoplastic cysts of the ovary may develop from the surface epithelium, follicles, endometriotic foci or may occasionally be the end result of an abscess. Most are asymptomatic, whatever their origin, but some become clinically apparent because of their large size, by undergoing torsion or their hormonal activity.

CYSTS DERIVED FROM THE SURFACE EPITHELIUM

The most common cysts derived from the surface epithelium are the hormonally inactive epithelial or serous inclusion cysts (Figure 7.5) which develop as a consequence of invagination of the surface epithelium of the ovary into the stroma, particularly at the site of ovulation.