The incidence and significance of polynuclear (:.
WILLIS
SHERRER.
BENJAMIN J.
GEKSON.
DONALD
Hrrlturwre.
WOODRUFF.
follicles
M.D. M.D. M.D
Marvlwd
T 13E PR ES EN c E of polynuclear follicles in both human and animal ovaries has been well documented. Known also as polyovular follicles and/or polynuclear ova. they are more common than uninuclear follicles in some mammalian species. Nevertheless. most investigators”. ‘I. I’, ‘CL ” have suggested that such multinuclear structures disappear in the human being i:l late embryonic or early postnatal life and thus are absent in the adult human ovary. The chance finding of hinuclear follicles in routine sections of the female gonad and their possible signiticance in the genesis of the benign cystic teratoma were the principle justifications fill- this study.
the study. ,411 patients lic irregularities were tion for study of the anovulation in several
had menstruated, although cycnot uncommon since the indicaovary had been infertility with instances.
Results The patients were divided into five age groups (Table I). Polynuclear follicles were discovered in the ovaries of all groups through the fifth decade (Fig. 1). As might be expected, the incidence decreased from 57 per cent recorded in patients under the age of 20 years to 0 per cent in those over the age of 40. The racial distribution of the patients is noted in Table II and corresponds to the patient population in the Woman’s Clinic of The Johns Hopkins Hospital. Furthermore, rhe racial distribution of those patients with polynuclear l’ollicles reflects accurately that of the study group. There was no indication that multinuclear follicles were more commonly found in the ovaries of patients using oral contraceptives as compared with those using other methods of contraception (Table III). The parity of those patients whose ovaries contained polynuclear follicles was low. However, many were young and had either infertility problems or pelvic inflammatory disease as the indication for surgical exploration (Table IV).
Material and methods Routine sections, usually two or three in number. from 16.3 ovaries that had been removed in the treatment of pelvic disease or gonadal dysfunction were studied for the presence of polynuclear follicles. The sections were stained with hemotoxylin and eosin. They had not been prepared especially for this study, and additional sections were obtained only if the initial ones rvere unsatisfactory for accurate interpretation. In addition, the cases that were studied were unselected clinically. No effort was made to choose a specific number of patients by race, parity, or social status, although patients with ovarian neoplasia were eliminated from
Comment Frm the Departnewts oj Gynecology und Obstetrtcs Pathology, The Johns Hopkins Mrdiral Institufions.
In 1870, Waldeyer” first reported the finding of “polyovular” follicles in the ovary of the dog. Schottlander” discovered numerous small follicles containing two to three oocytes in the ovaries of fetuses of various ages. Hartman” described from five to 10 ova in one follicle as well as “5 germinal vesicles in one ovum.” Others have made similar observations.
and
Pwtoltrd at the Eighty-seventh A~~nual Meeting oj the .4mrriran Association of Obstetricians and Gynecologists, Hot Springs, Virginia, September 9-l 1, 1976. Reprint reqursb: Dr. J. Donald Woodruff, Department Obstetrics and Gynecology, The Johns Hopkins Medical Institutionr, Baltimore, Maryland 21205.
qf
6
Volume Number
128 1
Incidence
Fig. 1. Polynuclear
follicles
in the normal
It has been reported that polynuclear follicles are seen more frequently in polycystic ovaries, particularly after gonadotropin stimulation. Kennedy and Donohue’ suggested that the high incidence of abortion in women receiving such stimulation may be due to the fertilization of polynuclear ova. Theories as to the origin of polynuclear follicles are many and varied. Simkins” suggested that they were formed by simultaneous enlargement of two cells within a nest of follicle cells. Rabl” believed that polyovulate follicles in the young girl subsequently separated into mononuclear follicles by the ingrowth of follicle epithelium. Hartman proposed that they resulted from division of polynuclear ova, concrescences of previously separate follicles, and failure of separation.
Relationship to genesis of teratomas Since the benign cystic teratoma is the most common ovarian tumor recorded during the early decades of life and since it appears to be of germ cell origin, the possible histogenetic relationship between the polynuclear follicle and the teratoma, specifically the mature variety, was an important facet of this study. Historically, two basic theories concerning the genesis of the teratoma have been proposed: (1) It was related to elements which, sequestered at an early stage of embryogenesis, developed at some later date into
ovary
Table
and significance
of a 22-year-old
I. Incidence
of polynuclear
follicles
7
patient.
of polynuclear
follicles
(PNF)
Cases with PNF Age
Total cases
WILLIS
SHERRER.
BENJAMIN J.
GEKSON.
DONALD
Hrrlturwre.
WOODRUFF.
follicles
M.D. M.D. M.D
Marvlwd
T 13E PR ES EN c E of polynuclear follicles in both human and animal ovaries has been well documented. Known also as polyovular follicles and/or polynuclear ova. they are more common than uninuclear follicles in some mammalian species. Nevertheless. most investigators”. ‘I. I’, ‘CL ” have suggested that such multinuclear structures disappear in the human being i:l late embryonic or early postnatal life and thus are absent in the adult human ovary. The chance finding of hinuclear follicles in routine sections of the female gonad and their possible signiticance in the genesis of the benign cystic teratoma were the principle justifications fill- this study.
the study. ,411 patients lic irregularities were tion for study of the anovulation in several
had menstruated, although cycnot uncommon since the indicaovary had been infertility with instances.
Results The patients were divided into five age groups (Table I). Polynuclear follicles were discovered in the ovaries of all groups through the fifth decade (Fig. 1). As might be expected, the incidence decreased from 57 per cent recorded in patients under the age of 20 years to 0 per cent in those over the age of 40. The racial distribution of the patients is noted in Table II and corresponds to the patient population in the Woman’s Clinic of The Johns Hopkins Hospital. Furthermore, rhe racial distribution of those patients with polynuclear l’ollicles reflects accurately that of the study group. There was no indication that multinuclear follicles were more commonly found in the ovaries of patients using oral contraceptives as compared with those using other methods of contraception (Table III). The parity of those patients whose ovaries contained polynuclear follicles was low. However, many were young and had either infertility problems or pelvic inflammatory disease as the indication for surgical exploration (Table IV).
Material and methods Routine sections, usually two or three in number. from 16.3 ovaries that had been removed in the treatment of pelvic disease or gonadal dysfunction were studied for the presence of polynuclear follicles. The sections were stained with hemotoxylin and eosin. They had not been prepared especially for this study, and additional sections were obtained only if the initial ones rvere unsatisfactory for accurate interpretation. In addition, the cases that were studied were unselected clinically. No effort was made to choose a specific number of patients by race, parity, or social status, although patients with ovarian neoplasia were eliminated from
Comment Frm the Departnewts oj Gynecology und Obstetrtcs Pathology, The Johns Hopkins Mrdiral Institufions.
In 1870, Waldeyer” first reported the finding of “polyovular” follicles in the ovary of the dog. Schottlander” discovered numerous small follicles containing two to three oocytes in the ovaries of fetuses of various ages. Hartman” described from five to 10 ova in one follicle as well as “5 germinal vesicles in one ovum.” Others have made similar observations.
and
Pwtoltrd at the Eighty-seventh A~~nual Meeting oj the .4mrriran Association of Obstetricians and Gynecologists, Hot Springs, Virginia, September 9-l 1, 1976. Reprint reqursb: Dr. J. Donald Woodruff, Department Obstetrics and Gynecology, The Johns Hopkins Medical Institutionr, Baltimore, Maryland 21205.
qf
6
Volume Number
128 1
Incidence
Fig. 1. Polynuclear
follicles
in the normal
It has been reported that polynuclear follicles are seen more frequently in polycystic ovaries, particularly after gonadotropin stimulation. Kennedy and Donohue’ suggested that the high incidence of abortion in women receiving such stimulation may be due to the fertilization of polynuclear ova. Theories as to the origin of polynuclear follicles are many and varied. Simkins” suggested that they were formed by simultaneous enlargement of two cells within a nest of follicle cells. Rabl” believed that polyovulate follicles in the young girl subsequently separated into mononuclear follicles by the ingrowth of follicle epithelium. Hartman proposed that they resulted from division of polynuclear ova, concrescences of previously separate follicles, and failure of separation.
Relationship to genesis of teratomas Since the benign cystic teratoma is the most common ovarian tumor recorded during the early decades of life and since it appears to be of germ cell origin, the possible histogenetic relationship between the polynuclear follicle and the teratoma, specifically the mature variety, was an important facet of this study. Historically, two basic theories concerning the genesis of the teratoma have been proposed: (1) It was related to elements which, sequestered at an early stage of embryogenesis, developed at some later date into
ovary
Table
and significance
of a 22-year-old
I. Incidence
of polynuclear
follicles
7
patient.
of polynuclear
follicles
(PNF)
Cases with PNF Age
Total cases
