Impact of luteoma during pregnancy on fetal development and its long-term effects into adulthood.

A woman in her 30s presents to the Differences in Sexual Development Programme at a tertiary care academic medical centre with vaginal stenosis and scarring. Her medical history is significant for virilisation in utero due to a maternal luteoma of pregnancy. Laboratory investigations at the time of birth showed elevated androgens in both mother and daughter. During infancy, she underwent clitoroplasty and vaginoplasty for correction of posterior vaginal fusion. She represented as an adult with vaginal stenosis, with associated physical and psychosocial implications. She was not able to insert a tampon or have penetrative intercourse. After examination and shared decision-making, the patient underwent cystoscopy, vaginoscopy and posterior vaginoplasty with the goal to create a normal calibre vagina. Postoperative dilator use was recommended to prevent restenosis of the introitus. In clinic follow-up, the patient was observed to have a normal calibre vagina.

Intra-abdominal mass aspirate from a cat in heat.

A 3-year-old intact female domestic shorthair cat was presented for the evaluation of a palpable intra-abdominal mass in the left caudal abdomen. The cat had a history of anorexia, depression and prolonged estrus over a period of about 1 month. Smears prepared from a fine needle aspirate of the mass revealed large round to oval cells arranged individually or in loose clusters surrounded by pink, fibrillar matrix material. Cytoplasm was basophilic, with many variably-sized vacuoles and variable numbers of small purple granules. The vacuoles within the cells were strongly positive with Oil-Red-O stain. The cytologic features were most suggestive of a neoplasm of epithelial cell origin or inadvertent aspiration of a fatty liver. At laparotomy, the mass was found to involve the left ovary. Histologically, the tumor consisted of dense sheets and nests of irregular polyhedral, pleomorphic cells with abundant, finely vesiculated cytoplasm. The tumor cells were separated into lobules by strands of connective tissue. Based on histologic evaluation, a diagnosis of ovarian luteoma was made. In this report, we document the cytologic and histologic features of an uncommon feline tumor, a luteoma, and address its possible misdiagnosis as hepatic lipidosis when using cytology alone to make a diagnosis.

[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.

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.

Granulosa theca cell tumor with luteoma in the ovary of a bonnet monkey (Macaca radiata).

A mass was identified on the left caudal region of the abdomen in a 13-year-old bonnet monkey (Macaca radiata). The mass was excised and diagnosed as granulosa theca cell tumor accompanied with luteoma based on the microscopic findings. Morphologically it appeared pink, round, firm multilobulated measured approximately 5 x 3 x 2.5 cm in dimension. Histologically the luteoma composed of polyhedral cells with pale strained vacuolated cytoplasm, centrally located nuclei with distinct cytoplasmic borders. Granulosa theca cell tumor appeared as densely packed spindle shaped fusiform cells arranged in interlacing bundles and whorled pattern with neoplastic cells appearing irregular shaped solid sheets. The concomitant development of granulosa theca cell tumor with luteoma in a single ovary is very rare and is the first reported case in a bonnet macaque to our knowledge.

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.

Luteoma estromal como causa de hirsutismo pós-menopausa / Estromal luteoma due post menopausal hirsutism

O objetivo deste trabalho é apresentar um caso de hirsutismo após a menopausa, provocado por um tumor de células esteróides (luteoma estromal) do ovário, atendido no Centro de Atendimento Integral à Saúde da Mulher (CAISM) da UNICAMP. Trata-se, geralmente, de um tumor benigno, pequeno e que ocorre com maior freqüência em mulheres idosas. Os autores chamam a atençao para a suposiçao diagnóstica de tumor ovariano em uma mulher após a menopausa com níveis elevados de testosterona, na qual afastou-se a possibilidade de tumor adrenal, mesmo sem haver um diagnóstico imagenológico prévio.