Follicle hemorrhage

Normal prenatal and postnatal ovarian development, with multiple nonovulatory hemorrhagic follicles as an adult, 30-40% incidence of ovarian cancer in 18 months Normal prenatal development, but insensitive to the development promoted by estrogens during puberty. Sensitive to progesterone and prolactin. 

The answer is B. The patient shows many signs of vitamin G deficiency or scurvy, which is seen most frequently in infants, the elderly, and in alcoholic patients. Particularly indicative of vitamin C deficiency are the multiple small hemorrhages that occur under the skin (petechiae) and nails and surrounding hair follicles. Bleeding gums are a classic indicator of scurvy. 

IgG is found in ovarian (intra)follicular fluid or corpus lutea secondary to ovarian (ovulation) hemorrhage or macrophage-mediated transport. Macrophages have been localized to ovarian stroma, to thecal layers of ovarian follicles, and within early, mid-, late, and regressing corpora lutea [162],... 

Examination typically reveals a marked conjunctivitis with a primarily follicular and papillary response of the palpebral conjunctiva.The follicles typically are worse in the inferior palpebral conjunctiva, with papillae more common in the superior. Preauricular lymphadenopathy is present in about 64% of patients at presentation and lasts approximately 1 week. Small subconjunctival hemorrhages are not an uncommon characteristic. 

Ovaries can be identified on CT and MRI due to their location and soft tissue characteristics. The landmark of the ovaries are follicular structures which can be best identified on T2-weighted MRI [8]. On CT, normal ovaries can be best identified after bowel contrast opacification. They are ovoid soft tissue structures with low attenuation areas which represent normal follicles (Fig. 8.2). Presence of a dominant folhde ranging more than 1 cm in size assists in ovarian identification. Hemorrhagic corpus luteum cysts may he identified by high attenuation values or a fluid-fluid level [9]. 

Corpus luteum cysts have thicker enhancing walls than follicle cysts following intravenous contrast application (Fig. 8.6). Corpus luteum cysts may contain blood with bright signal on Tl and T2 as a sign of subacute hemorrhage [8]. Resolution is expected in on follow-up after two to three menstrual cycles and proves the diagnosis of a functional cyst. 

The majority of ovarian cysts are foUicular cysts resulting from failure of rupture or of regression of the Graalian follicle. Under nonpregnant conditions, corpus luteum cysts derive fi om failure of regression or hemorrhage into the corpus luteum. 

Fig. 17.8. Torsion of a normal ovary. Transaxial T2WI at umbilical level. In a 14-year-old girl with excessive intermittent pelvic pain for several days, sonography detected an indeterminate solid right adnexal mass. MRI shows a predominantly low-signal-intensity mass with numerous small peripheral cysts (small arrows), representing displaced follicles. Normal left ovary( ) At surgery, the right ovary had undergone complete hemorrhagic infarction. Courtesy of Dr. K. Kinkel, Geneva...

Three or four hours after the follicular rupture, the follicle is replaced by the corpus luteum, a small structure measuring 1-2 cm in diameter. The corpus luteum is yellowish because the cells contain large amounts of lipid, and it often contains a central clot due to hemorrhage. The corpus luteum disappears after 2 weeks in the absence of pregnancy, but it remains well developed throughout pregnancy. 

Between the 10th and the 16th day after the onset of menstruation, ovulation is assumed to occur. The follicle ruptures as described above, and the thickened endometrium elaborates glycogen and secretes a thick mucoid material. If fecundation does not occur, the arteries that supplied the endometrium with blood shrink, ischemia develops, and the endometrium involutes. The involution is followed by opening of the constricted arteries and menstrual hemorrhage. 

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