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Introduction Autoimmune oophoritis is a rare condition, which provokes ovarian failure with either primary amenorrhea or secondary amenorrhea and a subsequent loss of fertility and ovarian hormonal function. The purpose of this report is to document the clinical findings from two patients with autoimmune oophoritis. Cases report Two cases of autoimmune oophoritis are presented whose histopathological findings were consistent with international literature. Both cases were histopathologically characterised by lymphocytic and plasmacytic inflammatory infiltrations around the cystic follicles. The inflammation was located both in the theca and granular layers. Conclusion Patients with autoimmune oophoritis should be recognised by the histopathology of the ovarian biopsies as they are at an increased risk of developing other autoimmune disorders. Introduction Premature ovarian failure (POF) is a condition characterised by amenorrhea, some hot flushes, elevated serum gonadotropin levels and hypooestrogenism with associated infertility in women before the age of 40 years1-4. The aetiologies of this condition include chromosomal anomalies (such as X chromosome monosomy, translocations or partial deletions), genetic predisposition (such as fragile X pre-mutations, BMP15 or DIAPH2 mutations), infectious diseases, complications of chemotherapy, pelvic radiotherapy, surgical interventions or surgery, enzymatic disorders and endometriosis. Premature ovarian failure might also be idiopathic or autoimmune2. Among a total of 266 patients with spontaneous POF, 4% were diagnosed to have autoimmune oophoritis3,4. Ovarian autoimmunity was first reported and serologically documented by Vallotton and Forbes in 19665. Autoimmune oophoritis is a distinct clinical entity and one of the causes of POF, particularly in women with secondary amenorrhea6-8. Autoimmune oophoritis generally occurs in the setting of autoimmune polyendocrine syndromes and is associated commonly with other major endocrine failures such as diabetes mellitus, Addison’s disease, hypoparathyroidism or hypothyroidism8-10. A wide clinical spectrum has also been demonstrated11. The aim of this report was to describe the clinical spectrum and the interesting pathological findings originating from small ovarian biopsies from two patients with autoimmune oophoritis. Case report Case 1 A 33-year-old woman presented with a 10-month history of secondary amenorrhoea and hot flushes. Menarche had occurred at an age of 14 years, she had developed secondary sex characteristics appropriately and had regular menses on a 28-day cycle. She had five full-term normal pregnancies without any miscarriages. On pelvic bimanual examination, an anteverted uterus was palpated, while both fallopian tubes and ovaries were impalpable. Pelvic ultrasonography disclosed normal-sized ovaries with bilateral multicystic structures, with the largest follicle measuring 1.2 cm. The thickness of the endometrium was 3.5 mm. Initial investigation showed her serum gonadotropin concentrations to be elevated: follicle stimulating hormone (FSH) at 40 mIU/ml and luteinizing hormone (LH) at 56 mIU/ml. 17-beta oestradiol was at 30 pg/ml (normal range: 30–100 pg/ml). Serum prolactin levels were normal and there was no evidence of hypoparathyroidism. Thyroid function tests were normal. Also, kidneys and liver function tests were normal. Serum electrolytes were normal. Proteinuria was negative. Serum adrenocorticotropin hormone levels were normal. The progesterone challenge test was negative. At exploratory laparoscopy, her ovaries appeared small and inactive. There were no signs of abdominal or pelvic inflammatory processes. Biopsies from both ovaries were obtained and endometrial curettage was performed as well. Grossly, two specimens had been obtained from the right ovary with a whitish-grey colour, measuring 0.7 cm and 1.2 cm in their greatest dimension, respectively, and one specimen had been obtained from the left ovary with white tan to grey colour measuring 1.6 cm in its greatest dimension. Also, the specimen from the endometrial biopsy measured 3.5 × 3 × 0.2 cm. At micro* Corresponding author Email: mnvarras@otenet.gr 1 Third Department of Obstetrics and Gynecology, ‘Elena Venizelou’ General Maternity Hospital, Athens, Greece 2 Fourth Department of Obstetrics and Gynecology, ‘Elena Venizelou’ General Maternity Hospital, Athens, Greece 3 Department of Pathology, ‘G. Chatzikosta’ General State Hospital, Ioannina, Greece 4 Department of Obstetrics and Gynecology, ‘G. Chatzikosta’ General State Hospital, Ioannina, Greece Ob st et ri cs & G yn ec ol og y

Autoimmune oophoritis: Clinical presentation of an unusual clinical entity