Polycystic ovarian syndrome in the exam

Getting a film with polycystic ovarian syndrome in a subfertile patient is one of the many exam set-pieces that can be prepared for.

Description

Transabdominal and transvaginal pelvic ultrasound show an anteverted uterus with a normal size. There is diffuse thickening of the endometrium to 17 mm. No myometrial or serosal abnormality seen.

Both ovaries are enlarged (>10 cc in volume) with multiple peripheral cysts arrayed around a prominent central echogenic stroma that are less than 9 mm in size, with a string of pearls appearance.

State number of follicles counted in each ovary and whether you would consider them as multifollicular. It would be worthwhile to exercise some caution as currently (at the time of edit in 2016), many centers have transitioned to new criteria and terminology (multifollicular >25 follicles), whereas others may still prefer Rotterdam criteria  (polycystic >12 follicles). This may be a valid point of discussion.

No dominant follicle (>10 mm) or corpus luteum is visualized.

I would correlate this with the clinical picture of subfertility, amenorrhea, hirsutism, acne, male pattern alopecia and hormone levels, particularly raised LH and low FSH. These findings are concordant with the Rotterdam criteria for polycystic ovarian syndrome.

Notes

• 40% have diffuse endometrial thickening either secondary to prolonged proliferative phase or endometrial hyperplasia 
• increased risk of endometrial carcinoma