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Postnatal Formation of Ovarian Stroma and Its Relation to Ovarian Pathology

Ovarian development was studied in 113 patients ranging from birth to 15 years of age. After a short pause the ovary becomes highly active during the first year, subsides slowly to a trough between ages 3 and 5 and then resumes activity. During the early activity, central ripening follicles and their associated edema expand the ovary and then hold the ground gained by the progressive conversion during atresia of theca and some granulosa into medullary stroma. This later becomes amorphous and reduced in quantity. Cortical stroma forms separately and concurrently by proliferation of the interfollicular mesenchyme to form a lattice. Externally this matures to the tunica and internally anchors some ripening follicles to contribute retrogressed theca to its deeper layers. Cellular ovarian stroma probably develops as a proliferative response of loose ovarian mesenchyme to stretch, and so forms round individual ripening follicles and round the ovary as a whole stretched by the follicular complement and its associated edema. At both sites, therefore, its formation is dependent on the follicular mechanism. This explains the stromal poverty of dysgenetic and related ovaries and the stromal excess of Stein‐Leventhal ovaries, while the direct follicular ancestry of medullary and some deep cortical stroma may explain the proneness of these sites to develop lutein foci and tumors of specifically gonadal morphology. A note is added on “Pflüger's tubes,” which furnish a little cortical stroma and show disturbed development along with that of the ovary in prematurity, Turner's syndrome and mongolism.