Antenatal diagnosis and management of pregnancy luteoma: A case report and literature review.

BACKGROUND: Pregnancy luoteomas are tumor-like ovarian lesions that emerge during pregnancy and spontaneously regress after delivery. Antenatal diagnosis is infrequently reported, and unnecessary surgery appears to be common in literature reports. CASE SUMMARY: A 28-year-old primigravida with bilateral adnexal masses was discovered at 32 + 5 weeks during prenatal ultrasound evaluation. Combined with clinical presentation, auxiliary examinations including blood test, magnetic resonance imaging, gastroscopy, and consultation of multi-disciplinary team, we successfully made a diagnosis of pregnancy luteoma and provided conservative management recommendations. A cesarean section was conducted on this patient at 34 + 2 weeks of gestation due to fetal distress. The newborn was small for gestational age but normal in appearance. We performed biopsies of the adnexal masses, which were confirmed to be pregnancy luteomas using both intraoperative frozen section and final pathological diagnosis. Serum testosterone, cancer antigen 125, and alpha-fetoprotein levels gradually declined and normalized on postoperative day 28. The masses significantly decreased in size as shown by ultrasonic and magnetic resonance imaging examination on postoperative day 7, with the ovaries returning to their normal size by postoperative day 30. CONCLUSION: Prenatal diagnosis of pregnancy luteoma poses a challenge, requiring hormonal examinations, ultrasound, magnetic resonance imaging, and gastrointestinal endoscopy for identification. Caution must be exercised to avoid overtreatment. While additional cases are needed to summarize the imaging features and effects of excess hormones on the both mother and fetus, further research is necessary for a comprehensive understanding.

Retrospective analysis of 26 cases of pregnancy luteoma.

BACKGROUND: Pregnancy luteoma is a rare hormone-dependent ovarian tumor-like lesion caused by increased androgenic activity during pregnancy. OBJECTIVE: To explore the clinical history, ultrasound manifestations, and differential diagnosis of pregnancy luteoma. METHOD: A retrospective analysis was conducted on 26 cases of pregnancy luteoma diagnosed by postoperative pathology, from 2009 to 2022. All cases were from two hospitals: Shanghai First Maternity and Infant Hospital and International Peace Maternity and Child Health Hospital. The clinical history data and ultrasound characteristics were analyzed and the relevant literature was reviewed. RESULTS: Among the 26 cases, five of them had preoperative ultrasound images. Among these five cases, three patients showed hyperechoic masses with less internal uniformity, while two demonstrated loculated anechoic zones, with clear boundary and regular morphology. Color Doppler showed no obvious internal blood flow signals, or that blood flow signals were visible within the cyst wall and hyperechoic mass. Among the cases, 16 had multiple gestations, while two visited the clinic due to sudden abdominal pain and a huge ovarian mass was found by ultrasonography. The ovarian lump was detected during routine obstetric ultrasound in three cases. The remaining were ovarian cysts found incidentally during caesarean section. Four patients presented with hairy manifestations and one patient had a deepened voice. CONCLUSION: There is no characteristic ultrasound of pregnancy luteoma, and its diagnosis is mainly based on clinical history data and laboratory tests.

Clinicopathologic features of pregnancy luteoma.

OBJECTIVE: This study aimed to explore the clinicopathological characteristics, immunophenotype, histological occurrence, diagnosis, and differential diagnosis of ovarian luteoma tumor of pregnancy. METHODS: The clinical features, histomorphology, immunohistochemistry, and reticular fiber staining results of 18 cases of luteoma tumors of pregnancy were analyzed, and related published studies were reviewed. RESULTS: The 18 cases of luteoma tumors were all women who had undergone multiple pregnancies. The tumors were 1.3-15 cm in size and brownish yellow or reddish brown in color, with a soft texture. Microscopic examination revealed the eosinophilic cytoplasm of tumor cells and diffuse hyperplasia. The results of the immunohistochemical analysis were as follows: α-inhibin, AE1/AE3, CD99, and vimentin were positive, while epithelial membrane antigen, S-100, HMB45, and MelanA were negative. One case was positive for MelanA. The staining results of reticular fibers showed that the argyrophilic reticular fibers were black surrounding the tumor cell nests. CONCLUSIONS: Luteoma tumor of pregnancy is a rare tumor-like lesion mostly appearing in late pregnancy. The gross, immunohistochemical staining, and reticular fiber staining results may help diagnose this disease. The disease needs to be differentiated from other diseases.

Luteoma del embarazo. Reporte de caso / Luteoma of pregnancy. A case report

Luteoma of pregnancy is an infrequent non-neoplastic pathology of the ovary. It is usually an incidental finding during the evaluation of a pregnant patient in the third trimester or during a cesarean section. Occasionally, it may raise suspicion of cancer, resulting in unnecessary surgical resection of the ovary. We present the case of a 34-year-old woman who was in her third pregnancy and during the cesarean section, a 9 cm tumor of the right ovary was incidentally found and resected. The histological study was compatible with luteoma of pregnancy.

El luteoma del embarazo es una patología no neoplásica del ovario, de incidencia poco frecuente. Suele presentarse como hallazgo incidental durante la evaluación de una paciente embarazada en el tercer trimestre o en el momento del acto quirúrgico de una cesárea. En ocasiones, puede llevar a sospechar una neoplasia maligna, derivando así en una resección quirúrgica innecesaria del ovario. Presentamos el caso de una mujer de 34 años que cursaba su tercera gestación y a quien, durante la cesárea, se le halló una tumoración ovárica derecha de 9 cm de diámetro que fue resecada. El estudio histológico fue compatible con luteoma del embarazo.

Miscellaneous tumour-like lesions of the ovary: cross-sectional imaging review.

Miscellaneous tumour-like ovarian lesions are histobiologically diverse, and are often mistaken for the more common ovarian cancers, leading to aggressive management. Knowledge of characteristic clinical, laboratory and imaging findings of these select non-neoplastic ovarian entities allows correct diagnoses and permits optimal management.

Pregnancy luteomas: clinical presentations and management strategies.

UNLABELLED: Pregnancy luteomas are rare, benign, neoplasms of the ovary thought to be caused by the hormonal effects of pregnancy. They are usually asymptomatic and found incidentally during imaging or surgery. However, they may present with virilization of the mother or infant or cause complications due to a mass effect or hemorrhage secondary to torsion. Luteomas spontaneously regress postpartum. We present a case of a woman with the classic presentation of a pregnancy luteoma and the common challenges of subsequent management. Pregnancy luteomas present a diagnostic and management challenge in that they can mimic the presentation of malignant ovarian tumors. There have been fewer than 200 case reports of pregnancy luteomas and a relative paucity of data to provide guidance for clinical management. However, certain general principles emerged from a review of modern cases. Management of pregnancy luteomas depends on the clinical situation. Luteomas present most commonly in the second half of pregnancy, with a solid ovarian mass that is frequently bilateral, elevated testosterone levels and some aspects of virilization. With high clinical suspicion for pregnancy luteoma, clinical monitoring and postpartum radiologic follow-up may be an appropriate management strategy to avoid unnecessary surgery. However, in some cases with atypical presentation or with complications from the mass, surgical intervention may be necessary for diagnostic or management purposes. Patients who present in the first half of pregnancy generally have more severe symptoms and are more likely to require surgical intervention for management of mass effect. When there is a high clinical suspicion for pregnancy luteoma, conservative management is appropriate since these tumors will usually regress spontaneously. After completing this CME activity, obstetrician/gynecologists should be better able to evaluate clinical presentations of pregnancy luteomas, examine the complexities involved in diagnosing neoplasms suspicious for pregnancy luteoma, and counsel patients about appropriate management and treatment options. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians, Pediatricians Learning Objectives: After completion of this article, the reader should be better able to evaluate the clinical presentations of pregnancy luteomas; examine the complexities involved in the diagnosis of neoplasms suspicious for pregnancy luteoma; and counsel patients on appropriate management and treatment for suspected luteomas.

Luteoma gestacional não virilizante simulando neoplasia ovariana / Pregnancy luteoma without virilization mistaken by an ovarian tumor

Objetivo: descrever um caso de ooforectomia em paciente com luteoma gestacional, um pseudotumor ovariano relacionado a uma resposta exagerada do estroma ovariano aos hormônios da gravidez que regride após o parto. Relato do caso: mulher de 42 anos, em sua terceira gestação, evoluiu sem intercorrências. Durante a realização de cesariana, observou-se a existência de tumoração ovariana bilateral, sendo realizada ooforectomia. A análise histopatológica demonstrou-se tratar-se de um luteoma gestacional. Considerações finais: por não constituir um tumor verdadeiro e pela tendência à regressão no pós-parto, readquirindo as dimensões normais, deve-se avaliar com cautela a realização de ooforectomias em pacientes gestantes que apresentem aumento das dimensões ovarianas.

Purpose:to report a case of pregnancy luteoma, an ovarian pseudotumors usually diagnosed during cesarian section or at postdelivery tubal ligation. After delivery the ovary size returns to normal in a few weeks. Case Report: A 46 year old female,(G 3, P 2) without complains. During cesarian section It was noticed an increase of the ovarian size, the approch was bilateral ooforectomy.The histhopathological diagnostic was pregnancy luteoma .Final Considerations: being just a pseudotumor that decrease after delivery the surgeon must remember this nosological entity, that is easily mistaken by true ovarian tumors, and try to avoid an ooforectomy.

Unilateral luteoma of pregnancy mimicking a malignant ovarian mass on magnetic resonance and ultrasound.

Luteoma of pregnancy is a rare, tumorlike ovarian mass that develops during pregnancy and regresses after delivery. Generally, these masses are discovered incidentally during cesarean delivery or tubal ligation. Some of these patients will develop hirsutism or virilization during late pregnancy with or without fetal masculinization due to circulating androgens. The imaging features of this entity have been only rarely reported. An incidentally discovered luteoma of pregnancy in a 23-year-old patient during routine obstetric ultrasound is described and the image features in ultrasound and magnetic resonance (MR) imaging are discussed and compared with other studies. The patient underwent surgery to extract this mass considering the imaging findings were suspicious for neoplasia and the size and location could have potentially caused dystocia. This type of mass can mimic ovarian neoplasia and a correlation with imaging and laboratory findings can avoid an unnecessary surgical procedure during pregnancy.

[Hyperreactive luteomas during pregnancy--symptoms and complications: a case report]. / Hyperreaktive Luteome in der Schwangerschaft--Symptomatik und Komplikationen: Ein Fallbericht.

A 27-year-old Caucasian (gravida 2 para 1) presented in week 16 of her twin pregnancy with worsening of hyperandrogenic symptoms. In week 17, she developed an acute abdomen due to a twisted, incarcerated right ovary, which was surgically removed. Histological analysis revealed a diffuse steroid cell hyperplasia. Postsurgery testosterone levels fell temporarily within normal limits, diminishing the hyperandrogenic symptoms. Over time androgen levels rose again slowly above normal values with clinical worsening of hirsutism. In the 32nd week of gestation, a cesarean section of two healthy female infants was necessary due to the development of preeclampsia. An ovarian biopsy revealed again the picture of hyperreactio luteinalis. Postpartum peripheral hormone levels fell within normal limits and the hyperandrogenic symptoms subsided.

Pregnancy luteoma presenting as ovarian torsion with rupture and intra-abdominal bleeding.

We report a case of pregnancy luteoma, which had undergone torsion in a 33-year-old Indian woman, who presented with severe abdominal pain and decreasing haemoglobin levels at 33 weeks gestation. Ultrasonography showed a right adnexal mass, probably ovarian in origin, with suspicious intratumoral bleed. The pain was treated symptomatically, and the symptoms improved. A successful induction of labour was then performed at 36 weeks gestation. The pain recurred almost immediately after the delivery, and she experienced another intra-abdominal bleed. A diagnostic laparotomy and a right salpingo-oophorectomy were performed, and the diagnosis of luteoma was made based on histology. We discuss the clinical presentation of this unusual tumour, though often asymptomatic, can rarely present with severe abdominal pain from complications like torsion with rupture, leading to massive intra-abdominal bleeding. We also discuss the possible radiological investigations which can be done during pregnancy.

Maternal luteoma of pregnancy presenting with virilization of the female infant.

BACKGROUND: Virilization in female newborns typically results from congenital adrenal hyperplasia, requiring immediate diagnosis and treatment. We report a rare cause of virilization, maternal pregnancy luteoma, responsible for virilization of both a newborn and the mother. Luteomas are usually asymptomatic tumour-like ovarian lesions of pregnancy that secrete androgens in only 25% of cases. Many female infants born to masculinized mothers will also be virilized. CASE: A term infant born with ambiguous genitalia was transferred to a referral centre for investigation, diagnosis, and treatment. Assessment identified Prader II-III genitalia, an elevated serum testosterone level, a normal serum 17-hydroxyprogesterone level, and a normal female karyotype (46,XX). The mother had had virilization from the second trimester and was found to have an elevated serum testosterone level. Pelvic ultrasound assessment in the mother showed a complex right ovarian mass. Laparotomy was performed, and the mass was excised. Histopathology examination confirmed a luteoma. CONCLUSION: High maternal serum testosterone levels due to a luteoma can result in virilization in the female newborn. This report emphasizes the need to consider possible underlying maternal pathology in evaluating a virilized female infant.

Krukenberg tumor mimicking pregnancy luteoma.

BACKGROUND: Pregnancy-associated Krukenberg tumor is very rare, and the diagnosis in pregnancy is even more difficult. Usually symptoms are attributed to pregnancy luteomas, which are hormone-active benign neoplasms. CASE: A 22-year-old female presented at the 28th week of gestation with rapid onset of hirsutism and acne since the 20th week of gestation. Physical and ultrasonographic examinations revealed bilateral ovarian solid masses which were considered as pregnancy luteomas. The patient underwent exploratory laparotomy due to the onset of ascites and elevated tumor markers four months after delivery. Histopathologic examination revealed adenocarcinoma with signet-ring-type cells. CONCLUSION: Krukenberg tumors should be considered in the differential diagnosis of pregnancy luteomas. Otherwise, early diagnosis of the tumor can be delayed.

Maternal and female fetal virilization caused by pregnancy luteomas.

OBJECTIVE: To present the maternal and female fetal virilization caused by excessive androgen secretion of pregnancy luteomas. DESIGN: Case report. SETTING: University-based teaching hospital. PATIENT(S): A nulligravida woman suffering from bilateral hydronephrosis and recurrent acute pyelonephritis caused by bilateral solid ovarian tumors presented virilization during the third trimester. Without prompt surgical intervention, the maternal hyperandrogenemia returned to a normal level and regression of bilateral ovarian tumors occurred spontaneously after a female fetus with clitoral hypertrophy and temporal hyperandrogenemia was delivered. In spite of lacking histology, the clinical course is compared to that of pregnancy luteomas. INTERVENTION(S): Noninvasive imaging assessment. MAIN OUTCOME MEASURE(S): Maternal and female fetal virilization. RESULT(S): Regression of androgen-secreting pregnancy luteomas and hyperandrogenism during the puerperium but apparent female fetal clitoral hypertrophy. CONCLUSION(S): The maternal and female fetal virilization was caused by exaggerating androgen secretion of bilateral ovarian solid tumors. Spontaneous regression of ovarian tumors and hyperandrogenemia during the puerperium is the natural course of pregnancy luteomas, not true neoplasms.

MR imaging of pregnancy luteoma: a case report and correlation with the clinical features.

We report here on a 26-year-old pregnant female who developed hirsutism and virilization during her third trimester along with a significantly elevated serum testosterone level. Abdominal US and MR imaging studies were performed, and they showed unique imaging features that may suggest the diagnosis of pregnancy luteoma in the clinical context. After the delivery, the serum testosterone level continued to decrease, and it returned to normal three weeks postpartum. The follow-up imaging findings were closely correlated with the clinical presentation.

Magnetic resonance imaging of pregnancy luteoma.

We present the magnetic resonance (MR) imaging findings of pregnancy luteoma in an asymptomatic woman at 32 weeks of gestation. MR imaging with a half-Fourier, single-shot, turbo spin-echo sequence showed multilocular cystic masses with thickened internal septa in bilateral adnexa. The MR findings were similar to those of other cystic tumors or tumor-like lesions of the ovary.

[Cushing's syndrome during pregnancy]. / Le syndrome de Cushing durant la grossesse.

The rare association of Cushing's syndrome and pregnancy is explained by the amenorrhea and sterility inherent to the syndrome. In the literature, 125 cases have been reported: 30 cases of early diagnosis and 95 others diagnosed in the second half of pregnancy. AT THE START OF PREGNANCY: When hypercorticism exists before pregnancy it is hardly secretory. Its diagnosis, at an early stage, is not hindered by the hormone modifications of pregnancy. Its aetiological treatment raises the problem of the compatibility in pursuing the latter. IN THE SECOND HALF OF PREGNANCY: The positive and aetiological diagnoses of Cushing's syndrome are difficult and its prevalence may therefore be underestimated. The evocative clinical signs are unspecific: excessive weight gain, hypertension of pregnancy and gestational diabetes. The 24-hour free hypercortisoluria and the absence of dexamethasone inhibition are of little diagnostic value after the 14th week of amenorrhea. The positive diagnosis therefore relies essentially on the abolition of the circadian rhythm of cortisol. The biological hyperandrogenia commonly observed is not discriminating. Adrenal aetiologies are frequent. Imaging must be performed to eliminate an adrenocortical tumor. PROGNOSIS: The maternal prognosis depends on the hypertension, preeclampsia, diabetes and the complications of Cushing's syndrome. It depends on the activity of the hypercorticism and its early aetiological treatment, which must not be delayed after pregnancy. The foetal prognosis depends on the maternal prognosis. It is represented by preterm delivery, hypotrophy and death of the foetus in utero. The therapeutic management must be symptomatic and aetiologic, maternal and obstetrical.

Pregnancy luteoma with granulosa cell proliferation: an unusual hyperplastic lesion arising in pregnancy and mimicking an ovarian neoplasia.

A pregnancy luteoma (PL) was incidentally found at a term cesarean section in a 27-year-old black woman without any endocrine abnormality. The lesion involved only the left ovary; it had a nodular and focal pseudoalveolar growth pattern and was associated with areas of tubular sertoliform component, consistent with granulosa cell proliferation. Immunohistochemistry revealed a diffuse positivity to Inhibin A, CD99, cytokeratin and vimentin. The ultrastructure was typical of steroid-producing cells. PL is a tumor-like lesion arising in pregnant women and often misdiagnosed as a neoplastic lesion; awareness of this rare entity and its differential diagnoses may avoid unnecessary surgery in young patients.

A gonadotrophin dependent stromal luteoma: a rare cause of post-menopausal virilization.

A stromal luteoma is an uncommon ovarian tumour in post-menopausal women, which presents rarely with hyperandrogenism and virilization. We present the case of a 64-year-old woman referred for evaluation of virilization which had developed over 5 years. Testosterone, FSH and LH were markedly inhibited following the administration of a GnRH analogue, suggesting a gonadotrophin dependent, testosterone secreting ovarian tumour, which could not be localized with imaging techniques. Surgery revealed normal sized ovaries with no apparent lesions, but microscopic examination showed a small stromal luteoma in the right ovary and severe stromal hyperthecosis in the adjacent and contralateral ovarian stroma. We conclude that stromal luteoma is an uncommon cause of virilization in post-menopausal women. This case illustrates, to our knowledge for the first time, that a stromal luteoma is not autonomous but is gonadotrophin dependent.