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The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
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Obstetrics and Gynegology2026№7

Polycystic ovary syndrome: stromal fibrosis, extracellular matrix remodeling and modern methods of morphological assessment

DOI
https://dx.doi.org/10.18565/aig.2026.33

Bulanov D.V., Tereshchenko V.A., Abramyan S.A.

Pirogov Russian National Research Medical University, Ministry of Health of Russia (Pirogov University), Moscow, Russia

Objective. To systematize current data (2020-2025) on cortical fibrosis and thickening of the ovarian tunica albuginea in polycystic ovary syndrome (PCOS), assessments of the collagen matrix using picrosirius red under linear polarized light (PSR PL) and second harmonic generation (SHG), as well as their association with hyperandrogenism and stromal mechanobiology.
Materials and methods. A targeted search was conducted in PubMed, Scopus and eLibrary (2020–2025) using the following combinations of keywords: PCOS, ovarian cortex/capsule, tunica albuginea, fibrosis, collagen morphometry, picrosirius red, polarized light, second harmonic generation, hyperandrogenism, elastography. The review includes original research, meta-analyses and methodological studies that used the quantitative PSR PL metrics (proportion of ‘thick’ fibers, I/III ratio, orientation/anisotropy, fractal dimension) and/or SHG (density, smoothness index, straightness/waviness) and their correlations with biochemical and phenotypic characteristics of PCOS.
Results. In PCOS, the following are observed: (i) an increase in the thickness of the tunica albuginea and cortical fibrosis with a shift towards collagen I and increased fiber alignment; (ii) convergence of PSR PL and SHG metrics, indicating increased stromal stiffness; (iii) positive correlations between quantitative collagen parameters and biochemical hyperandrogenism in various PCOS phenotypes; (iv) acceptable reproducibility of quantitative metrics when standardizing staining/polarization settings and segmentation algorithms (CT FIRE/CurveAlign, CNN approaches); (v) signs of reversibility in preclinical models of hyperandrogenism, where antifibrotic/endocrine interventions reduce collagen load and partially normalize morphometry. The following gaps were identified: a lack of standardized thresholds for diagnostic stratification, limited multicenter validation, small sample sizes, and infrequent cross-validation with elastography.
Conclusion. Cortical fibrosis and thickening of the tunica albuginea are reproducible morphological markers of PCOS, pathogenetically associated with hyperandrogenism and stromal rigidity. Standardized collagen morphometry using PSR PL/SHG with reporting of key metrics and parallel assessment of hormonal status and elastography appears promising for diagnostic verification, phenotyping and monitoring of treatment. Multicenter studies are required with standardized protocols and established clinically significant thresholds.

Authors’ contributions. Bulanov D.V. – developing the concept and design of the study, critical revision and edition of the manuscript; Tereshchenko V.A. – systematization and analysis of literary sources, writing the main text of the review, correcting and formatting the article; Abramyan S.A. – selection and analysis of scientific literature, writing the text of the manuscript.
Conflicts of interest. Authors declare lack of the possible conflicts of interests.
Funding. The study was conducted without sponsorship.
Generative Artificial Intelligence. Artificial intelligence tools, including generative language models, were not used in the preparation of this research article.
For citation: Bulanov D.V., Tereshchenko V.A., Abramyan S.A. Polycystic ovary syndrome: stromal fibrosis, 
extracellular matrix remodeling and modern methods of morphological assessment.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (7): 24-30 (in Russian)
https://dx.doi.org/10.18565/aig.2026.33

Keywords

polycystic ovary syndrome
cortical fibrosis
ovarian tunica albuginea
collagen
picrosirius red
polarization microscopy
second harmonic generation
hyperandrogenism
elastography
Full text (in Russian)

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Received 03.02.2026

Accepted 05.06.2026

About the Authors

Dmitriy V. Bulanov, PhD, Department of Pathological Anatomy and Clinical Pathological Anatomy, Pirogov Russian National Research Medical University,
Ministry of Health of Russia (Pirogov University), 117513, Russia, Moscow, Ostrovityanov str., 1, dbulanov81@gmail.com, https://orcid.org/0009-0005-3772-6643
Varvara A. Tereshchenko, Pirogov Russian National Research Medical University, Ministry of Health of Russia (Pirogov University), 117513, Russia, Moscow,
Ostrovityanov str., 1, v.a.tereshchenko@mail.ru, https://orcid.org/0009-0007-8054-9958
Sofia A. Abramyan, Pirogov Russian National Research Medical University of the Ministry of Health of Russia (Pirogov University), 1 Ostrovityanova St., Moscow,
117513, Russia, abramyansofia2005@gmail.com, https://orcid.org/0009-0007-8421-0476
Сorresponding author: Varvara A. Tereshchenko, v.a.tereshchenko@mail.ru

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