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Morphological pattern and misdiagnosis in polycystic ovarian syndrome

Sosnova E.A., Gracheva T.S., Demura T.A., Krot M.A.
Архив акушерства и гинекологии им. В.Ф. Снегирева
Т. 9, № 3, С. 143-151
Опубликовано: 23 2022
Тип ресурса: Статья

DOI:10.17816/2313-8726-2022-9-3-143-151

Аннотация:

<strong><em>INTRODUCTION:</em></strong> 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.

<em><strong>AIM</strong>: </em>In this study, we sought to analyze the morphological verification of PCOS.

<strong><em>MATERIALS AND METHODS: </em></strong>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 (<em>n</em>=121) were sampled for histological examination.

The patients were referred to different gynecological hospitals: a municipal clinical hospital (group 1, <em>n</em>=54), a research center (group 2, <em>n</em>=48) and a commercial clinic (group 3, <em>n</em>=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 (p<sup>2</sup>) and Wilcoxon criteria were further applied. Differences were considered significant at <em>p</em> 0.05.

<strong><em>RESULTS: </em></strong>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 (<em>n</em>=6, 14[%]) and group 2 with the so-called PCOS-like conditions (<em>n</em>=37, 86[%]).

<strong><em>CONCLUSIONS:</em></strong> 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.

Язык текста: Русский
ISSN: 2313-8726
Sosnova E.A. Elena A.
Gracheva T.S. Tat’yana S.
Demura T.A. Tat’yana A.
Krot M.A. Marina A.
Первый Московский государственный медицинский университет им. И. М. Сеченова Минздрава России (Сеченовский Университет)
I. M. Sechenov First Moscow State Medical University (Sechenov University)
Morphological pattern and misdiagnosis in polycystic ovarian syndrome
Текст визуальный электронный
Архив акушерства и гинекологии им. В.Ф. Снегирева
Eco-Vector
Т. 9, № 3 С. 143-151
2022
Синдром поликистозных яичников
Polycystic ovarian syndrome
морфология яичников
ovarian morphology
бесплодие
infertility
гистология
histology
Статья

<strong><em>INTRODUCTION:</em></strong> 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.

<em><strong>AIM</strong>: </em>In this study, we sought to analyze the morphological verification of PCOS.

<strong><em>MATERIALS AND METHODS: </em></strong>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 (<em>n</em>=121) were sampled for histological examination.

The patients were referred to different gynecological hospitals: a municipal clinical hospital (group 1, <em>n</em>=54), a research center (group 2, <em>n</em>=48) and a commercial clinic (group 3, <em>n</em>=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 (p<sup>2</sup>) and Wilcoxon criteria were further applied. Differences were considered significant at <em>p</em> 0.05.

<strong><em>RESULTS: </em></strong>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 (<em>n</em>=6, 14[%]) and group 2 with the so-called PCOS-like conditions (<em>n</em>=37, 86[%]).

<strong><em>CONCLUSIONS:</em></strong> 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.