The function of female reproductive organs is regulated across estrous cycle by the
hypothalamic–pituitary–gonadal axis through complex feedback loops. These feedback systems
can be perturbed by ovarian toxicants accompanied by abnormal hormone secretion, disrupted
estrous or menstrual cycles, or identifiable histopathological changes in the reproductive
tract; detailed histopathological evaluations can help establish their underlying
mechanisms[1]. Understanding the
morphology and function of these structures can help clarify the mechanisms pertaining to
ovarian toxicants.The ovary has two distinct functional components required for estrous cyclicity: the
follicles and corpora lutea (CL). The follicles play a critical role in ovulation[2], while CL are an endocrine gland that forms
after ovulation[3]. The CL have several
unique features. The first is their temporal nature: CL have a limited lifespan in many
species, depending on the fate of the oocyte released by the preceding ovulatory
follicle[2]. Second, they synthesize and
secrete progesterone (P4). P4 has numerous biological effects on the reproductive tract,
including facilitating implantation in the uterine endometrium and supporting the uterine
environment to sustain pregnancy[2]. Third,
there is a marked species diversity in the mechanisms that evolved for controlling the
structure and function of CL. In primates and domestic animals, CL develop and function for
a finite interval (approximately 2 weeks) during the ovarian cycle. However, rodents do not
form truly functional CL during the incomplete estrous cycle unless mating results in
pregnancy or pseudopregnancy[2].Rodents are generally used for ovarian toxicity evaluations. The incomplete rodent estrous
cycle stably lasts 4 to 5 days and is clearly distinguished by its morphological features
during each estrous cycle stage[4]. In
addition, cyclic changes in the levels of reproductive hormones, such as P4, estradiol-17β,
follicle-stimulating hormone, luteinizing hormone (LH), and prolactin (PRL), are common
(Fig. 1), and each estrous stage can be recognized in vaginal smear observations[5], [6], [7]. Although
some aspects of reproductive regulatory mechanisms differ between rodents and humans, an
understanding of these differences will allow the assessment of the risk of human ovarian
toxicity.
Fig. 1.
Time-course changes in reproductive hormone levels; progesterone (P4), prolactin
(PRL), estradiol, luteinizing hormone (LH), and follicle-stimulating hormone. The rat
estrous cycle is subdivided into four subsequent phases, proestrus, estrus,
metestrus/diestrus 1, and diestrus/diestrus 2. Reproduced with permission from the
Oxford University Press; taken from Smith et al. Endocrinology. 96:
219–226. 1975.
Time-course changes in reproductive hormone levels; progesterone (P4), prolactin
(PRL), estradiol, luteinizing hormone (LH), and follicle-stimulating hormone. The rat
estrous cycle is subdivided into four subsequent phases, proestrus, estrus,
metestrus/diestrus 1, and diestrus/diestrus 2. Reproduced with permission from the
Oxford University Press; taken from Smith et al. Endocrinology. 96:
219–226. 1975.In this review, the histological and functional characteristics of CL in rats are
summarized, and representative luteal toxicity changes are presented for improving luteal
toxicity evaluation in preclinical toxicity research.
Key factors in luteinization after ovulation
Ovulation and subsequent luteinization represent a complicated cascade of molecular
events[2], [8]. During ovulation, progesterone receptor (PR)
and cyclooxygenase-2 (COX-2) are key mediators[8]. Peroxisome proliferator-activated receptor γ (PPARγ) is a target of PR
regulation in preovulatory follicles and controls ovulation[9]. Luteinization is comprised of two major processes: 1)
termination of proliferation with rapid hypertrophy and differentiation of steroidogenic
follicular cells (granulosa cells and theca cells) into luteal cells, and 2) the rapid
growth of blood vessels (angiogenesis) into the previous granulosa layer of the
follicle[2]. Vascular endothelial growth
factor (VEGF), angiopoietins, and platelet-derived growth factor (PDGF) play critical roles
in luteal angiogenesis[2],
[10].
Histological characteristics of CL in rats
In rat ovaries, multiple types of CL are generated, which then regress over several estrous
cycles. There are two main types of CL: those that are newly formed by the current ovulation
(new CL), and CL remaining from prior estrous cycles (old CL)[4], [11]. The histological characteristics of new CL and old CL are well described
in the literature[4], [12], [13]. Briefly, new CL during the estrus to diestrus stages are
characterized by basophilic cytoplasm. At the diestrus stage, the new CL attain their
largest size with polygonal and finely vacuolated luteal cells. At the proestrus stage, the
basophilic CL become eosinophilic and begin luteolysis, characterized by apoptosis of
individual luteal cells, and vacuolation may be observed in these CL[12]. Old CL were also eosinophilic. However, they
showed decreased cytoplasmic vacuolation and increased fibrous tissue composition compared
to the new CL. During the luteal regression process, CL almost fully regressed after four
estrous cycles in Sprague-Dawley (SD) rats[14] (Fig. 2). However, luteal regression begins approximately two or more stages later in Wistar
Hannover (WH) rats[13]; therefore, the
regression is slower in WH rats than in SD rats.
Fig. 2.
Time-course histological changes of luteal regression. New corpora lutea (CL) were
composed of luteal cells with a small amount of basophilic cytoplasm. Old CL, after 1
cycle, reached maximum size and were characterized by luteal cells with abundant
eosinophilic cytoplasm and distinct cell borders, as well as indistinct interstitial
cells. Old CL after 2 cycles were smaller than Old CL after 1 cycle, had conspicuous
interstitium, and luteal cell borders were slightly indistinct. Old CL after 3 cycles
had more conspicuous interstitium and were smaller than Old CL after 2 cycles. After 4
cycles of new formation, CL almost completely regressed. Bars represent 50 µm.
Modified from Taketa et al. Toxicol Pathol. 39:
372–380. 2011.
Time-course histological changes of luteal regression. New corpora lutea (CL) were
composed of luteal cells with a small amount of basophilic cytoplasm. Old CL, after 1
cycle, reached maximum size and were characterized by luteal cells with abundant
eosinophilic cytoplasm and distinct cell borders, as well as indistinct interstitial
cells. Old CL after 2 cycles were smaller than Old CL after 1 cycle, had conspicuous
interstitium, and luteal cell borders were slightly indistinct. Old CL after 3 cycles
had more conspicuous interstitium and were smaller than Old CL after 2 cycles. After 4
cycles of new formation, CL almost completely regressed. Bars represent 50 µm.
Modified from Taketa et al. Toxicol Pathol. 39:
372–380. 2011.
P4 secretion during the incomplete estrous cycle in rats
Rodents have two discrete time points in the estrous cycle during which P4 increases. The
first occurs in the afternoon of the proestrus stage, and the second occurs from the
metestrus to diestrus stages[6],
[15] (Fig. 1). Preovulatory P4 is secreted at the proestrus stage by
Graafian follicles, depending on LH. In metestrus and diestrus, P4 is secreted from CL, but
independently of LH. The luteal secretion of P4 from the metestrus to the diestrus stages
reaches peak values at midnight of metestrus before falling to basal levels as a result of
luteolysis[5]. The drop-off in P4 marks
the beginning of the functional regression of CL.
P4 biosynthesis in the rat CL
P4 biosynthesis in CL is divided into the following steps: uptake, synthesis, and transport
of cholesterol, and the processing of cholesterol into P4, as summarized in Fig. 3. Cholesterol is preferentially obtained from circulatory high- and low-density
lipoproteins (HDL and LDL, respectively); HDL is the main source of cholesterol for CL in
rodents[16], [17]. Scavenger receptor class B type I (SR-BI) is
considered an authentic HDL receptor that mediates the selective uptake of HDL-derived
cholesterol esters[18]. After uptake, the
storage and turnover of free cholesterol in lipid droplets are processed through
acyl-coenzyme A-cholesterol acyl transferase-catalyzed cholesterol ester formation[2]. Intracellular transport of hydrophobic free
cholesterol appears to be actively directed by various proteins, including sterol carrier
proteins[2]. These cholesterol esters are
transported to the outer mitochondrial membrane and then to the inner mitochondrial membrane
by several proteins, including steroidogenic acute regulatory protein (StAR)[19]. Once cholesterol reaches the inner
mitochondrial membrane, its transformation into P4 begins. In this step, mitochondrial P450
cholesterol side-chain cleavage (P450scc) and 3β-hydroxysteroid dehydrogenase (3β-HSD),
located in the smooth endoplasmic reticulum, play major roles[20], [21].
Fig. 3.
A schema of the progesterone (P4) biosynthesis process in the luteal cells.
High-density lipoprotein (HDL) is the main source of cholesterol for CL in rodents.
Scavenger receptor class B type I (SR-BI) is the authentic HDL receptor mediating the
selective uptake of HDL-derived cholesterol esters. After uptake, the storage and
turnover of free cholesterol in lipid droplets is processed through acyl coenzyme
A-cholesterol acyl transferase (ACAT-1)-catalyzed cholesterol ester formation.
Intracellular transport of hydrophobic, free cholesterol appears to be actively
directed by proteins including sterol carrier proteins (SCP2). The cholesterol esters
are transported to the outer mitochondrial membrane and then to the inner membrane by
proteins including steroidogenic acute regulatory protein (StAR). Once the cholesterol
reaches the inner mitochondrial membrane, mitochondrial P450 cholesterol side-chain
cleavage (P450scc) transforms cholesterol into pregnenolone and 3β-hydroxysteroid
dehydrogenase (3β-HSD) in the smooth endoplasmic reticulum (ER), and transforms
pregnenolone into P4. In CL with functional regression, 20α-hyroxysteroid
dehydrogenase (20α-HSD) catabolizes P4 into the inactive progestin,
20α-dihydroprogesterone (20α-DHP).
A schema of the progesterone (P4) biosynthesis process in the luteal cells.
High-density lipoprotein (HDL) is the main source of cholesterol for CL in rodents.
Scavenger receptor class B type I (SR-BI) is the authentic HDL receptor mediating the
selective uptake of HDL-derived cholesterol esters. After uptake, the storage and
turnover of free cholesterol in lipid droplets is processed through acyl coenzyme
A-cholesterol acyl transferase (ACAT-1)-catalyzed cholesterol ester formation.
Intracellular transport of hydrophobic, free cholesterol appears to be actively
directed by proteins including sterol carrier proteins (SCP2). The cholesterol esters
are transported to the outer mitochondrial membrane and then to the inner membrane by
proteins including steroidogenic acute regulatory protein (StAR). Once the cholesterol
reaches the inner mitochondrial membrane, mitochondrial P450 cholesterol side-chain
cleavage (P450scc) transforms cholesterol into pregnenolone and 3β-hydroxysteroid
dehydrogenase (3β-HSD) in the smooth endoplasmic reticulum (ER), and transforms
pregnenolone into P4. In CL with functional regression, 20α-hyroxysteroid
dehydrogenase (20α-HSD) catabolizes P4 into the inactive progestin,
20α-dihydroprogesterone (20α-DHP).P4 secretion from CL in rodents is regulated by a balance between synthesis and catabolism.
It depends not only on the amount of P4 synthesized by the luteal cells but also on the
expression of the enzyme 20α-hydroxysteroid dehydrogenase (20α-HSD), which catabolizes P4
into the inactive progestin, 20α-dihydroprogesterone (20α-DHP). Once 20α-HSD is expressed in
CL as the initial step in functional luteolysis, P4 secretion is reduced, and 20α-DHP
becomes the major steroid secreted by luteal cells[22].The steroidogenic and luteolytic gene expression in the new CL dramatically changes during
the estrous cycle. An overview of luteal gene expression during the estrous cycle is shown
in Fig. 4[23]. The new CL at the metestrus
stage, which can secrete P4, show notably high steroidogenic (e.g., SR-BI,
StAR, P450scc, and 3β-HSD) and low
luteolytic gene (e.g., 20α-HSD and PGF2α-R)
levels[23]. Luteolytic genes in the new
CL were remarkably low at the estrus and metestrus stages, and gradually increase
thereafter[23]. In the old CL,
relatively high steroidogenic and markedly high luteolytic gene levels were consistently
maintained throughout the estrous cycle[23].
Fig. 4.
Overview of steroidogenic and luteolytic gene levels in new and old CL across the
estrous cycle in rats. The sizes of the circles represent the levels of steroidogenic
genes (gray circles) and luteolytic genes (black circles). The new CL at metestrus
(bold line), which have the capacity for P4 secretion, showed notably high
steroidogenic gene and low luteolytic gene levels. Luteolytic genes in the new CL were
remarkably low at estrus and metestrus, and gradually increased thereafter. In the old
CL, relatively high steroidogenic and markedly high luteolytic gene levels were
consistently retained throughout the estrous cycle. Reproduced with permission from
the Elsevier; taken from Taketa et al. Exp Toxicol
Pathol. 64: 775–782. 2012.
Overview of steroidogenic and luteolytic gene levels in new and old CL across the
estrous cycle in rats. The sizes of the circles represent the levels of steroidogenic
genes (gray circles) and luteolytic genes (black circles). The new CL at metestrus
(bold line), which have the capacity for P4 secretion, showed notably high
steroidogenic gene and low luteolytic gene levels. Luteolytic genes in the new CL were
remarkably low at estrus and metestrus, and gradually increased thereafter. In the old
CL, relatively high steroidogenic and markedly high luteolytic gene levels were
consistently retained throughout the estrous cycle. Reproduced with permission from
the Elsevier; taken from Taketa et al. Exp Toxicol
Pathol. 64: 775–782. 2012.
Roles of PRL in luteal function in rodents
In rodents, PRL plays a crucial role in both luteal activation and luteolysis. PRL directly
stimulates luteal P4 production by upregulating steroidogenic enzymes such as 3β-HSD and
preventing P4 degradation by inhibiting 20α-HSD expression[2]. In contrast, PRL induces luteolysis. A proestrus preovulatory
PRL surge induces luteal cell apoptosis by activating the Fas pathway and functional
regression of CL and facilitating the recruitment of monocytes/macrophages into CL[24]. Therefore, PRL-activating agents may induce a
luteotrophic effect, whereas PRL-inhibiting agents may disrupt the luteal regression
process.
Functional and structural regression of the rat CL
Luteal regression is divided into functional and structural regressions. The decrease in P4
is a marker of functional regression of CL in rodents. Structural regression occurs after
the initial decline in P4 and is morphologically observed as luteal cell apoptosis[24]. In functional regression, several factors,
including prostaglandin F2 alpha (PGF2α) and LH, have been implicated in the downregulation
of luteal P4 production[25],
[26]. PGF2α stimulates the
expression and activity of 20α-HSD[27].
Meanwhile, several signals, including PRL, PGF2α, tumor necrosis factor-alpha, and Fas
ligand, have been implicated in the induction of cell death that is required for the
structural regression of CL[24],
[28], [29], [30].
Practical approaches for the evaluation of luteal toxicity in rats
In general, luteal toxicity should be evaluated by considering antemortem data including
clinical signs, body weight, food consumption, and clinical pathology, as well as postmortem
data including gross pathology, organ weight, and histopathological examination of the
female reproductive organs and other related organs such as the pituitary, mammary, and
adrenal glands. The age of rats should be considered for the evaluation because age
significantly impacts the histological appearance of the female reproductive system and can
be challenging in distinguishing test article-related changes from normal developmental or
senescent changes[31]. For the examination
of live animals, daily vaginal smear observation is recommended because estrous cycle
disruption is one of the most sensitive parameters for detecting ovarian/luteal toxicity and
can be useful for determining the mode of toxicity[1]. Test article-related effects on CL are sometimes recognized as changes
in size, color, or organ weight during necropsy. In histopathological examinations, since
the ovary has a complicated structure, the bilateral ovary should be transversely dissected
with a maximum cut surface to accurately detect luteal changes. Other female reproductive
organs, including the uterus and vagina, must be carefully examined for identifying the
estrous cycle, and a connection should be made with the ovarian/luteal changes. The mammary
gland is an important tissue related to luteal toxicity. Since PRL plays critical roles in
both the mammary gland and CL, if the luteal changes are accompanied by mammary gland
changes, the relationship of PRL should be considered for determining its toxicity. The
adrenal glands are also important tissues in luteal toxicity because CL and adrenal cortex
are the main tissues involved in steroid hormone synthesis. If direct toxicity in the
adrenal cortex is observed, CL should be carefully evaluated considering their effect on
steroidogenesis and vice versa. Since angiogenesis is a critical process for luteinization,
CL should be carefully evaluated if any changes resulting from anti-angiogenesis are
suspected in various organs/tissues (e.g., epiphyseal growth plate thickening,
adrenocortical necrosis/hemorrhage, and incisor tooth dental dysplasia)[10], [32]. When test article-related histopathological changes in CL are
observed, it is important to determine whether the changes are caused by a direct effect or
by other associated factors. For example, a decrease in the number of CL can be induced not
only by an inhibitory effect of a test article on ovulation or luteal function but also by
nonspecific stress following severe anorexia due to the toxicity of a test article[12], [33], [34].For the mode of toxicity analysis, measurement of serum/plasma hormone levels, gene/protein
expression analysis, special staining, or immunohistochemical analysis can provide pivotal
information on a case-by-case or step-by-step basis[10], [35]. Since
CL is controlled by the upstream hypothalamic–pituitary system, it is often difficult to
explain the mode of toxicity in vivo. In such cases, in
vitro evaluation approaches using primary cell or tissue cultures, independent of
the effects of associated organs or hormones, may be informative[36], [37].
Representative luteal toxicological lesions in rats
Hypertrophy, CL
Hypertrophy of CL (Fig. 5) is histologically characterized by a large CL compared with that of the most
recent diestrus stage and enlarged luteal cells with lightly abundant basophilic or
eosinophilic cytoplasm. Hypertrophic luteal cells sometimes contain intracytoplasmic fine
vacuoles.
Fig. 5.
Luteal cell hypertrophy induced by 2-week administration of ethylene glycol
monomethyl ether (EGME), sulpiride, or atrazine. Luteal cells become hypertrophied
with abundant eosinophilic cytoplasm following EGME, sulpiride, or atrazine
treatment compared to respective control CL at diestrus stage. Asterisks indicate
hypertrophied CL. Bars represent 500 µm, and bars in the inset images represent 20
µm. Reproduced with permission from the Oxford University Press; taken from Taketa
et al. Toxicol Sci. 121: 267–278. 2011.
Luteal cell hypertrophy induced by 2-week administration of ethylene glycol
monomethyl ether (EGME), sulpiride, or atrazine. Luteal cells become hypertrophied
with abundant eosinophilic cytoplasm following EGME, sulpiride, or atrazine
treatment compared to respective control CL at diestrus stage. Asterisks indicate
hypertrophied CL. Bars represent 500 µm, and bars in the inset images represent 20
µm. Reproduced with permission from the Oxford University Press; taken from Taketa
et al. Toxicol Sci. 121: 267–278. 2011.There are two main causes of this change: 1) direct activation of steroidogenesis in
luteal cells and 2) luteal cell activation with hyperprolactinemia. First, ethylene glycol
monomethyl ether (EGME) and atrazine induce luteal hypertrophy following repeated
administration[35],
[36], [38]. EGME is used in various industrial
products, such as detergents. EGME and its active metabolite, 2-methoxy acetic acid,
induce hypersecretion of P4 from luteal cells both in vivo and in
vitro[35],
[36], [37]. Atrazine is a chlorotriazine herbicide,
that is a potent endocrine disruptor that alters the central nervous system regulation of
the reproductive system in mammals[39].
This change is histologically characterized by hypertrophy of both the new and old CL. The
serum P4 level increased, accompanied by histopathological vaginal mucinous
degeneration.Second, D2 antagonists such as sulpiride, which is clinically used as an atypical
antipsychotic drug, induce luteal cell hypertrophy[35]. In rats, D2 antagonists block the inhibitory effect of dopamine on
PRL release, which results in the preservation of functional CL and produces a
pseudopregnant state[40]. In this change,
ovary weight may be increased. Not all CL are affected, but only new CL are activated and
show hypertrophy with increased serum PRL levels. Since hyperprolactinemia is the cause of
this change, lobuloalveolar hyperplasia in the mammary gland is also histologically
observed. In the vagina, mucification was observed due to an increase in P4 levels.
Vacuolation, CL
Histopathologically, microvesicular or macrovesicular cytoplasmic vacuolation of luteal
cells in CL, other than CL of the most recent ovulation at diestrus/proestrus has been
observed. The affected luteal cells may become enlarged without clear degeneration or
single-cell necrosis.Vacuolation of luteal cells (Fig. 6) can occur due to the inhibition of steroid synthesis, which leads to lipid
accumulation within the cells[12].
Vacuolation of CL accompanied by vacuolation of the adrenal glands has been described in
anthracycline compounds[41]. Luteal cells
can also be affected in cases of phospholipidosis, of which foamy cytoplasmic vacuolation
can be indicative[12]. Since luteal cell
vacuolation is typically observed as part of the degeneration seen at the proestrus stage,
vacuolation of the luteal cells is thought to be diagnosed in the case of increased
numbers of vacuolated CL or vacuolations observed in CL at stages other than the proestrus
stage.
Fig. 6.
Representative images of vacuolation in luteal cells. The experimental detail is
unknown. Reproduced with permission of the Japanese Society of Toxicologic Pathology
from Dixson et al. Nonproliferative and proliferative lesions of
the rat and mouse female reproductive system. J Toxicol Pathol. 27:
1S–107S. 2014.
Representative images of vacuolation in luteal cells. The experimental detail is
unknown. Reproduced with permission of the Japanese Society of Toxicologic Pathology
from Dixson et al. Nonproliferative and proliferative lesions of
the rat and mouse female reproductive system. J Toxicol Pathol. 27:
1S–107S. 2014.
Degeneration/Necrosis, CL
In this change, massive degeneration or coagulative central necrosis of the luteal cells
was noted in CL (Fig. 7). Hyaline changes or mineralization may occasionally be seen[32]. Although apparent degeneration of the
luteal cells is normally observed in CL of the most recent ovulation during proestrus in
SD rats, treatment-related degeneration or necrosis of CL is observed in both new and old
CL. It should be noted that WH rats normally show necrotic areas with or without foamy
macrophage accumulation in old CL[13].
Therefore, it is sometimes difficult to distinguish whether the change is
treatment-related in WH rats.
Fig. 7.
Degeneration/necrosis of CL in the ovaries of rats treated with sunitinib, a
potent inhibitor of vascular endothelial growth factor (VEGF), platelet-derived
growth factor (PDGF), stem cell factor receptor (KIT), FMS-like tyrosine kinase-3
(FLT3), and rearranged during transfection (RET) receptors, at 6 mg/kg/day for up to
6 months (×200 magnification). Note necrosis (a) and mineralization (b). Reproduced
with permission from the SAGE Publications; taken from Patyna et
al. Toxicol Pathol. 36: 905–916. 2008.
Degeneration/necrosis of CL in the ovaries of rats treated with sunitinib, a
potent inhibitor of vascular endothelial growth factor (VEGF), platelet-derived
growth factor (PDGF), stem cell factor receptor (KIT), FMS-like tyrosine kinase-3
(FLT3), and rearranged during transfection (RET) receptors, at 6 mg/kg/day for up to
6 months (×200 magnification). Note necrosis (a) and mineralization (b). Reproduced
with permission from the SAGE Publications; taken from Patyna et
al. Toxicol Pathol. 36: 905–916. 2008.VEGF receptor inhibitors induce this change[10], [32]. In
the process of luteinization from the avascular Graafian follicle, dramatic
vascularization (angiogenesis) is observed in new CL, and one of the principal growth
factors driving this process is VEGF, whose cognate receptor is expressed on endothelial
cells[10]. Therefore, the lesion is
thought to be due to concomitant vessel regression and reduced vascular perfusion in
CL.
Hemorrhagic cystic degeneration, CL
The change is grossly observed as nodular enlargement of the ovary, characterized by
abnormal multilocular areas of red discoloration[10]. Histologically, they show degeneration, compression, necrosis, and
rupture of CL with loss of the ovarian cortex and hemorrhage into the interstitial space
(Fig. 8)[10]. In less severely affected
cases, the changes are characterized by single-cell necrosis of the luteal cells, which
develop into cystic dilatation and enlargement with hemorrhaging into the central lumen.
In the new CL, the earliest morphological change was the dilatation of fine walled
capillaries or sinusoids[10].
Fig. 8.
Images of hemorrhagic cystic degeneration of CL. (A) Gross photograph of an ovary
from a nude rat treated with platelet-derived growth factor receptor (PDGFR) a and b
inhibitors compared to a control ovary (upper inset). The ovary was enlarged, with
abnormal nodular areas of red discoloration. The lower inset shows a severely
enlarged ovary. (B and C) Sub-gross images from WH rats treated with PDGFR a and b
inhibitors showing severe (B) and minimal (C) cystic hemorrhagic
dilatation/degeneration of CL. In (B), the ovary was severely dilated with
hemorrhage. Residual abnormal CL are present (arrowheads) with areas of hemorrhage
in the central lumen. In (C), CL were abnormal, with dilated and hemorrhagic central
cavities. (D) Higher power photomicrograph of Fig. 1B (boxed area: original magnification ×20) showing an abnormal CL
with several dilated sinusoids (*). Note the absence of interstitial cells
(pericytes/endothelium) (arrowheads) throughout CL. Reproduced with permission from
the SAGE Publications; taken from Hall et al. Toxicol
Pathol. 44: 98–111. 2016.
Images of hemorrhagic cystic degeneration of CL. (A) Gross photograph of an ovary
from a nude rat treated with platelet-derived growth factor receptor (PDGFR) a and b
inhibitors compared to a control ovary (upper inset). The ovary was enlarged, with
abnormal nodular areas of red discoloration. The lower inset shows a severely
enlarged ovary. (B and C) Sub-gross images from WH rats treated with PDGFR a and b
inhibitors showing severe (B) and minimal (C) cystic hemorrhagic
dilatation/degeneration of CL. In (B), the ovary was severely dilated with
hemorrhage. Residual abnormal CL are present (arrowheads) with areas of hemorrhage
in the central lumen. In (C), CL were abnormal, with dilated and hemorrhagic central
cavities. (D) Higher power photomicrograph of Fig. 1B (boxed area: original magnification ×20) showing an abnormal CL
with several dilated sinusoids (*). Note the absence of interstitial cells
(pericytes/endothelium) (arrowheads) throughout CL. Reproduced with permission from
the SAGE Publications; taken from Hall et al. Toxicol
Pathol. 44: 98–111. 2016.This change is induced by platelet-derived growth factor receptor (PDGFR)
inhibitors[10]. In the significant
angiogenesis during luteinization, PDGF and VEGF, whose cognate receptor is expressed on
pericytes[10], are critical factors.
The lesion is likely due to increased vessel fragility resulting from endothelial
proliferation and active pericyte recruitment and attachment, as these types of vessels
are hyperpermeable[10].
Cyst, luteal
A luteal cyst (Fig. 9) develops after the follicle has ovulated and fluid or blood accumulates within the
follicle, causing it to expand and transform into a luteinized cyst[12]. The cyst is completely lined by several
layers of polygonal luteal cells with abundant eosinophilic and finely vacuolated
cytoplasm. An unovulated oocyte may occasionally be observed within the cavity. The cyst
was generally larger than the normal CL.
Fig. 9.
Luteal cyst in rats treated with mifepristone, which is the synthetic steroid with
antiprogesterone and antiglucocorticoid activities. (a) Multiple fluid-filled luteal
cysts (LC) were observed. Bars show 200 µm. (b) Large cyst lined by thin (open
arrowhead) and massive (arrows) luteinized cell layers. Bars show 50 µm. From Tamura
et al. J Toxicol Sci. 34: SP31–42. 2009.
Luteal cyst in rats treated with mifepristone, which is the synthetic steroid with
antiprogesterone and antiglucocorticoid activities. (a) Multiple fluid-filled luteal
cysts (LC) were observed. Bars show 200 µm. (b) Large cyst lined by thin (open
arrowhead) and massive (arrows) luteinized cell layers. Bars show 50 µm. From Tamura
et al. J Toxicol Sci. 34: SP31–42. 2009.PR and COX-2 induced by the LH surge in cumulus cells affect the function and formation
of the cumulus cell-enclosed oocyte complex in the ovulatory process[8]. PR or COX-2 inhibitors such as mifepristone
and indomethacin induce luteal cysts in rats[42], [43]. These
cysts are thought to be associated with anti-progesterone activity or COX-2 inhibition
during the ovulatory process, resulting in incomplete luteinization.
Unovulated oocyte, CL
This lesion was characterized by old CL-containing oocyte in the central part of CL
(Fig. 10). The unovulated oocyte in CL showed degeneration similar to that in atretic
follicles. PR and COX-2 play critical roles in the ovulatory process, as mentioned
above[8]. PR or COX-2 null mice show an
unovulated CL phenotype[8]; therefore, PR
antagonists and COX-2 inhibitors may induce these lesions. PPARα/γ agonists induce this
change in rats[44]. Since PPARγ has
important roles in PR regulation in the granulosa cells of the preovulatory follicles and
controls ovulation[9], the state of PPARγ
activation is thought to induce the luteinization of the pseudo-ovulated follicle.
Accompanied by this change, “follicle, luteinized”, “luteinized, nonovulatory follicle”,
or “luteinized unruptured follicle” can also be observed with the same mechanism of
action[12].
Fig. 10.
Image of unovulated CL. CL-retained oocytes (arrows) were observed in the ovaries
of rats treated with peroxisome proliferator-activated receptor α/γ (PPARα/γ) dual
agonist for 4 weeks. From Sato et al. J Toxicol
Sci. 34: SP137–SP146. 2009.
Image of unovulated CL. CL-retained oocytes (arrows) were observed in the ovaries
of rats treated with peroxisome proliferator-activated receptor α/γ (PPARα/γ) dual
agonist for 4 weeks. From Sato et al. J Toxicol
Sci. 34: SP137–SP146. 2009.
Increased number, CL
The histological feature of this change was an increased number of CL, but with normal
size (Fig. 11). Additionally, the ovary weight may be increased. This is caused by decreased PRL
release, resulting in inhibition of the preovulatory PRL surge, which is an important
event in structural luteolysis, and decreased luteolysis is observed during late proestrus
without estrous cycle disruption. Thus, the number of non-degenerating CL increased with
each successive cycle, both new and old CL were observed, and the number of old CL
increased.
Fig. 11.
Representative image of increased number of CL. The experimental detail is
unknown. Reproduced with permission of the Japanese Society of Toxicologic Pathology
from Dixson et al. Nonproliferative and proliferative lesions of
the rat and mouse female reproductive system. J Toxicol Pathol. 27:
1S–107S. 2014.
Representative image of increased number of CL. The experimental detail is
unknown. Reproduced with permission of the Japanese Society of Toxicologic Pathology
from Dixson et al. Nonproliferative and proliferative lesions of
the rat and mouse female reproductive system. J Toxicol Pathol. 27:
1S–107S. 2014.D2 agonists, such as bromocriptine, inhibit PRL secretion, including the preovulatory PRL
surge, and induce an increased number of CL in rats[45]. This can also result from superovulation caused by increased
ovulation per cycle. PMSG or hCG induces superovulation and can lead to this
change[46].
Decreased number/absent, CL
The diagnostic features of this lesion are a decreased number or a complete lack of new
and/or old CL (Fig. 12). Concomitant changes in ovarian morphology vary depending on the cause of the
disruption in ovulation and the duration without ovulation. A decreased number of old CL
indicates a lack of normal estrous cycling over the past 3 to 4 weeks[12]. A lower number of new CL, but the presence
of old CL, indicates that ovulation or estrous cycling has been interrupted within the
past 1 to 3 cycles[12].
Fig. 12.
Representative image of decreased number or absent CL. The experimental detail is
unknown. Follicular cysts were also observed in the ovary. Reproduced with
permission of the Japanese Society of Toxicologic Pathology from Dixson et
al. Nonproliferative and proliferative lesions of the rat and mouse
female reproductive systems. J Toxicol Pathol. 27: 1S–107S.
2014.
Representative image of decreased number or absent CL. The experimental detail is
unknown. Follicular cysts were also observed in the ovary. Reproduced with
permission of the Japanese Society of Toxicologic Pathology from Dixson et
al. Nonproliferative and proliferative lesions of the rat and mouse
female reproductive systems. J Toxicol Pathol. 27: 1S–107S.
2014.It should be noted that a decreased number of CL can be induced not only by an inhibitory
effect of a test article on ovulation or luteal function, but also by nonspecific stress
subsequent to severe anorexia due to the toxicity of a test article[33], [34].Accompanied by this change, a decrease in the number of large follicles and/or an
increase in atretic follicles may be observed. These are common features when estrous
cyclicity is disrupted, and this morphological lesion is observed in senescent ovaries.
Therefore, “atrophy, ovary” or “age-related atrophy” are thought to be the appropriate
diagnoses when the ovary shows a totally atrophic histology with decreases in the number
of CL and large antral follicles and an increase in the number of atretic follicles.
Disclosure of Potential Conflicts of Interest
The author declares no potential conflicts of interest with respect to this article.