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.

A puzzling ovarian tumour: pregnancy luteoma with diffuse endometriosis.

BACKGROUND: Pregnancy luteoma is a distinctive non-neoplastic hormone dependent lesion arising in pregnancy and mimicking an ovarian tumour. Fewer than 200 cases have been described in the English-language literature. Its clinical and morphological features are characteristic and must be considered in order to prevent diagnostic misinterpretation. To the best of our knowledge the association of pregnancy luteoma with endometriosis has not been reported in literature to date. CASE REPORT: A 30-year-old pregnant woman with no particular past medical history, consulted her gynaecologist at 17 weeks gestation for routine check-up. The patient was asymptomatic and did not show any signs of virilization. Ultrasonography disclosed a left adnexal heterogeneous mass measuring 7 cm in diameter with intramural vegetations. The right ovary was unremarkable. The patient underwent salpingo-oophorectomy considering the imaging findings were suspicious for malignancy. Histologically, the lesion was constituted of large sheets of luteinized polygonal cells with abundant eosinophilic cytoplasm and small round nuclei devoid of atypia and mitotic figures. In addition, there were several ectopic endometrial glands surrounded by abundant decidualized or edematous stroma. Immunohistochemically, these glands were immunoreactive for cytokeratin 7. The final pathological diagnosis was pregnancy luteoma associated with diffuse endometriosis. CONCLUSIONS: Because of its relative rarity, pregnancy luteoma is likely to be clinically misinterpreted and overtreated, as in the present case.

Management of ovarian disease in pregnancy.

The ovary is a complex structure that is responsible for maintaining the endocrine support for a pregnancy during the first trimester until the placenta is sufficiently developed to assume this role. Most ovarian disorders of pregnancy actually relate to pre-existing ovarian conditions such as polycystic ovary syndrome and premature ovarian insufficiency. Both of these are associated with increased complications in pregnancy and require careful monitoring. Ovarian disorders that are a particular consequence of the hormonal milieu of pregnancy such as pregnancy luteoma (PL) and hyperreactio luteinalis (HL) are rare. However, they have important implications for both the mother and the foetus since they can be confused with ovarian malignancy leading to unnecessary surgery. This review focuses on the salient aspects of management of these ovarian conditions during pregnancy.

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.