-
Endocrinology Feb 2017Androgen excess (hyperandrogenism) is a common endocrine disorder affecting women of reproductive age. The potential causes of androgen excess in women include... (Review)
Review
Androgen excess (hyperandrogenism) is a common endocrine disorder affecting women of reproductive age. The potential causes of androgen excess in women include polycystic ovary syndrome, congenital adrenal hyperplasia (CAH), adrenal tumors, and racial disparity among many others. During pregnancy, luteoma, placental aromatase deficiency, and fetal CAH are additional causes of gestational hyperandrogenism. The present report reviews the various phenotypes of hyperandrogenism during pregnancy and its origin, pathophysiology, and the effect of hyperandrogenism on the fetal developmental trajectory and offspring consequences.
Topics: Androgens; Animals; Female; Fetal Development; Humans; Hyperandrogenism; Pregnancy; Pregnancy Complications
PubMed: 27967205
DOI: 10.1210/en.2016-1801 -
Physiological Research 2011Hyperandrogenic states in pregnancy are almost always the result of a condition that arises during pregnancy. The onset of virilization symptoms is often very fast. The... (Review)
Review
Hyperandrogenic states in pregnancy are almost always the result of a condition that arises during pregnancy. The onset of virilization symptoms is often very fast. The mother is protected against hyperandrogenism by a high level of SHBG, by placental aromatase and a high level of progesterone. The fetus is protected from the mother's hyperandrogenism partly by the placental aromatase, that transforms the androgens into estrogens, and partly by SHGB. Nevertheless there is a significant risk of virilization of the female fetus if the mother's hyperandrogenic state is serious. The most frequent cause of hyperandrogenic states during pregnancy are pregnancy luteoma and hyperreactio luteinalis. Hormonal production is evident in a third of all luteomas, which corresponds to virilization in 25-35 % of mothers with luteoma. The female fetus is afflicted with virilization with two thirds of virilized mothers. Hyperreactio luteinalis is created in connection with a high level of hCG, e.g. during multi-fetus pregnancies. This condition most frequently arises in the third trimester, virilization of the mother occurs in a third of cases. Virilization of the fetus has not yet been described. The most serious cause of hyperandrogenism is represented by ovarian tumors, which are fortunately rare.
Topics: Adrenal Gland Neoplasms; Adrenal Glands; Adrenocortical Adenoma; Adrenocortical Carcinoma; Adult; Androgens; Aromatase; Female; Fetus; Humans; Hyperandrogenism; Luteoma; Ovarian Neoplasms; Ovary; Placenta; Pregnancy; Pregnancy Complications; Ultrasonography, Prenatal; Virilism
PubMed: 21114372
DOI: 10.33549/physiolres.932078 -
Medicine Jul 2023Pregnancy luoteomas are tumor-like ovarian lesions that emerge during pregnancy and spontaneously regress after delivery. Antenatal diagnosis is infrequently reported,... (Review)
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.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Adult; Luteoma; Ovarian Neoplasms; Cesarean Section; Ovarian Cysts; Pregnancy Complications, Neoplastic; Prenatal Diagnosis
PubMed: 37505122
DOI: 10.1097/MD.0000000000034521 -
Cureus Oct 2022Luteoma of pregnancy is a rare, benign neoplasm arising from the ovary, which occurs due to pregnancy-induced hormones.This rare ovarian lesion was first described by...
Luteoma of pregnancy is a rare, benign neoplasm arising from the ovary, which occurs due to pregnancy-induced hormones.This rare ovarian lesion was first described by Sternberg and Barclay in 1966. Our case is unusual as the ovarian mass was misdiagnosed as ruptured ectopic pregnancy. Only three such cases have been previously reported in the literature. A 28-year-old multigravida with three months of amenorrhea presented with vaginal bleeding, abdominal pain, and gradually increasing vertigo for six days with increased intensity in the last four hours. On examination, she was conscious and oriented, clinically moderate pallor was present, her pulse rate was 112 beats per minute (bpm), and her blood pressure (BP) was 98/68 mm Hg. On abdominal examination, there was no palpable abdominal mass, but left iliac fossa guarding and tenderness were present. On per-vaginal examination, the uterus was eight weeks in size, the right fornix was free, the left fornix was full and tender, and cervical motion tenderness was present. Her urine pregnancy test was positive. Transvaginal sonography was performed in the emergency setting, which showed a bulky uterus with thickened endometrium and a non-visualized right ovary, and the left ovary was seen adjacent to a hyperechoic collection in the pouch of Douglas of size 3.5×3.5×1.8 cm, likely organized hematoma; there was free fluid in the pouch of Douglas, and left forniceal tenderness was also present. In view of the clinical evidence of tachycardia and hypotension, an exploratory laparotomy was performed for suspected ruptured ectopic pregnancy, and the ovarian mass was excised. The histopathological examination (HPE) of the ovarian mass showed findings suggestive of luteoma of pregnancy. There is an extreme paucity of literature on luteoma of pregnancy. That, along with the rarity of the lesion, results in it often not being kept in mind as a differential diagnosis on clinical or radiological examination, thereby leading to more aggressive management. Obstetricians and gynecologists need to be aware of this condition so that it is kept as a differential diagnosis in patients presenting with adnexal masses. A vigilant outlook will help in preventing unnecessary radical surgery during pregnancy, thereby preserving the ovary and reducing morbidity in these young females.
PubMed: 36465744
DOI: 10.7759/cureus.30900 -
Archives of Pathology & Laboratory... Mar 2010Numerous benign, proliferative, or reactive processes, often related to hormone stimulation or inflammation, occur throughout the female genital tract and may mimic... (Review)
Review
CONTEXT
Numerous benign, proliferative, or reactive processes, often related to hormone stimulation or inflammation, occur throughout the female genital tract and may mimic benign or malignant tumors. Several of the more common pseudoneoplastic lesions are discussed in this article, including microglandular hyperplasia of the cervix mimicking well-differentiated endometrial adenocarcinoma, reactive epithelial changes in the fallopian tubes mimicking adenocarcinoma or carcinoma in situ, and pregnancy changes in the ovary including pregnancy luteoma and large solitary luteinized follicular cyst of pregnancy and puerperium that may mimic ovarian neoplasms.
OBJECTIVES
To discuss and illustrate several common lesions of the female genital tract that mimic neoplasms.
DATA SOURCES
Material derived from consultation cases and review of the literature.
CONCLUSIONS
Many benign hyperplastic or reactive processes that occur in the female genital tract may be mistaken for neoplasms both clinically and pathologically. Awareness of the features of such lesions will aid in their correct diagnosis and prevent overtreatment of benign processes.
Topics: Adult; Diagnosis, Differential; Female; Genital Diseases, Female; Genital Neoplasms, Female; Granuloma, Plasma Cell; Humans; Pregnancy
PubMed: 20196667
DOI: 10.5858/134.3.393 -
Journal of Reproduction & Infertility 2022Luteoma of pregnancy is a rare, non-neoplastic lesion of the ovary which mimics ovarian tumor. It develops hirsutism or virilization during pregnancy and regresses in...
BACKGROUND
Luteoma of pregnancy is a rare, non-neoplastic lesion of the ovary which mimics ovarian tumor. It develops hirsutism or virilization during pregnancy and regresses in postpartum phase spontaneously. A few number of cases are described in literature. The synchronization of ovarian luteoma with uterine leiomyomas is a rare condition; to the best of my knowledge, the association of both conditions is not reported till date.
CASE PRESENTATION
A 35 year old multiparous woman presented with mass and pain in abdomen came to the gynecology department of Uttar Pradesh University of Medical Sciences in India. On examination, a hard mass in uterus was diagnosed. Ultrasonography revealed a highly vascular uterine adnexal mass possibly arising from ovary with malignant features. Hysterectomy with bilateral salpingo-oophorectomy was done and this specimen with separate mass was sent for histopathology. Right sided ovary was measured 3×3 , well demarcated with solid brown areas. CA -125 (cancer antigen -125) level was raised. A separate tumor was measured 15×12×8 and it was smooth while cut surface was grey/white with whirling and hemorrhagic foci.
RESULTS
The section from ovary revealed luteoma of pregnancy. Endometrium microscopy confirmed pregnancy. Section from another mass/tumor showed leiomyoma with degenerations.
CONCLUSION
Pregnancy luteoma is a pregnancy induced lesion which mimics malignancy so, it is clinically misinterpreted and over diagnosed. Histopathological investigation is mandatory to diagnose and prevent unnecessary surgeries. The synchronous ovarian luteoma with uterine leiomyoma is a rare condition which represents unusual response to altered hormonal effect in pregnancy; therefore, more studies should be done to understand its pathogenesis.
PubMed: 36045881
DOI: 10.18502/jri.v23i1.8455 -
Acta Obstetricia Et Gynecologica... Apr 2024This study aimed to investigate the imaging features, clinical characteristics and neonatal outcomes of pregnancy luteoma. (Review)
Review
INTRODUCTION
This study aimed to investigate the imaging features, clinical characteristics and neonatal outcomes of pregnancy luteoma.
MATERIAL AND METHODS
We retrospectively analyzed patients with pregnancy luteoma admitted to the First Affiliated Hospital of Sun Yat-sen University between January 2003 and December 2022. We recorded their imaging features, clinical characteristics and neonatal outcomes. Additionally, we reviewed relevant studies in the field.
RESULTS
In total, 127 cases were identified, including eight from our hospital and 119 from the literature. Most patients (93/127, 73.23%) were of reproductive age, 20-40 years old, and 66% were parous. Maternal hirsutism or virilization (such as deepening voice, acne, facial hair growth and clitoromegaly) was observed in 29.92% (38/127), whereas 59.06% of patients (75/127) were asymptomatic. Abdominal pain was reported in 13 patients due to compression, torsion or combined ectopic pregnancy. The pregnancy luteomas, primarily discovered during the third trimester (79/106, 74.53%), varied in size ranging from 10 mm to 20 cm in diameter. Seventy-five cases were incidentally detected during cesarean section or postpartum tubal ligation, and 39 were identified through imaging or physical examination during pregnancy. Approximately 26.61% of patients had bilateral lesions. The majority of pregnancy luteomas were solid and well-defined (94/107, 87.85%), with 43.06% (31/72) displaying multiple solid and well-circumscribed nodules. Elevated serum androgen levels (reaching values between 1.24 and 1529 times greater than normal values for term gestation) were observed in patients with hirsutism or virilization, with a larger lesion diameter (P < 0.001) and a higher prevalence of bilateral lesions (P < 0.001). Among the female infants born to masculinized mothers, 68.18% (15/22) were virilized. Information of imaging features was complete in 22 cases. Ultrasonography revealed well-demarcated hypoechoic solid masses with rich blood supply in 12 of 19 cases (63.16%). Nine patients underwent magnetic resonance imaging (MRI) or computed tomography (CT), and six exhibited solid masses, including three with multi-nodular solid masses.
CONCLUSIONS
Pregnancy luteomas mainly manifest as well-defined, hypoechoic and hypervascular solid masses. MRI and CT are superior to ultrasonography in displaying the imaging features of multiple nodules. Maternal masculinization and solid masses with multiple nodules on imaging may help diagnose this rare disease.
Topics: Adult; Female; Humans; Infant, Newborn; Pregnancy; Young Adult; Cesarean Section; Hirsutism; Luteoma; Ovarian Neoplasms; Retrospective Studies; Virilism
PubMed: 37710408
DOI: 10.1111/aogs.14672 -
Case Reports in Obstetrics and... 2021Pregnancy luteomas are rare, benign, ovarian neoplasms resulting from increased androgenic activity during pregnancy. Often, they occur asymptomatically and are only...
BACKGROUND
Pregnancy luteomas are rare, benign, ovarian neoplasms resulting from increased androgenic activity during pregnancy. Often, they occur asymptomatically and are only diagnosed incidentally during imaging or surgery: cesarean section or postpartum tubal ligation. Most common symptoms associated with pregnancy luteoma include acne, deepening of voice, hirsutism, and clitoromegaly. Most pregnancy luteomas regress spontaneously postpartum. Thus, the management of pregnancy luteomas depends on the clinical situation.
CASE
We report a case of 28-year-old gravida 2, para 1 who presented at 39 + 1 weeks of gestation with prolonged labor and delivered by emergency cesarean. Intraoperatively, a huge left ovarian mass was identified and resected, and tissue was sent for histopathology and a diagnosis of pregnancy luteoma was made after the pathological report.
CONCLUSION
The present report emphasizes that pregnancy luteoma is a benign neoplasm and imprudent surgical intervention should be reserved. Proper imaging techniques, preferably MRI or ultrasonography that visualize the size of the ovary and reproductive hormonal profiles, would suffice for the diagnosis and management of pregnancy luteoma.
PubMed: 33833884
DOI: 10.1155/2021/6695117 -
Journal of Ovarian Research May 2023During pregnancy, both ovarian hyperstimulation syndrome (OHSS) and pregnancy luteoma could manifest as massive ascites, enlarged ovaries, or elevated serum levels of...
BACKGROUND
During pregnancy, both ovarian hyperstimulation syndrome (OHSS) and pregnancy luteoma could manifest as massive ascites, enlarged ovaries, or elevated serum levels of cancer antigen 125 (CA125), and atypical cells may be found in the ascitic fluid of OHSS patients. Whether this should be treated aggressively as peritoneal carcinomatosis is controversial.
CASE PRESENTATION
A 35-year-old G2P1A1 woman with secondary infertility had a successful pregnancy after one cycle of assisted reproductive technology. The patient complained of lower abdominal distension, oliguria, and poor appetite 19 days after embryo transplantation. She was diagnosed with late-onset OHSS. Although the size of the ovaries decreased bilaterally to the normal range at 12 weeks of gestation after prompt medical care, the ascites increased again after an initial decreasing trend. Elevated serum levels of CA125 (191.1 IU/mL), and suspected adenocarcinoma cells were observed in the ascitic fluid. Although further magnetic resonance imaging examination or diagnostic laparoscopy was recommended, the patient was provided with supportive treatment and closely monitored upon her request. Surprisingly, her ascites diminished, and serum level of CA125 started to decline at 19 weeks of gestation. During cesarean section, pathological examination of the solid mass in the right ovary revealed pregnancy luteoma, which was presumably the other cause of the intractable ascites.
CONCLUSIONS
Caution should be exercised in cases of suspicious malignant ascites during pregnancy. This may due to OHSS or pregnancy luteoma, in which abnormalities usually regress spontaneously.
Topics: Humans; Pregnancy; Female; Adult; Ovarian Hyperstimulation Syndrome; Ascites; Luteoma; Cesarean Section; Peritoneal Neoplasms; Ovarian Neoplasms
PubMed: 37194026
DOI: 10.1186/s13048-023-01186-2 -
BMC Veterinary Research Aug 2020This is the first report about a vaginal leiomyoma concomitant with an ovarian luteoma in a bitch.
BACKGROUND
This is the first report about a vaginal leiomyoma concomitant with an ovarian luteoma in a bitch.
CASE PRESENTATION
A 11-year-old intact female Labrador retriever was referred because of anuria, constipation and protrusion of a vaginal mass through the vulvar commissure. The bitch had high serum progesterone concentration (4.94 ng/ml). Because of the possibility of progesterone responsiveness causing further increase of the vaginal mass and since the bitch was a poor surgical candidate a 10 mg/kg aglepristone treatment was started SC on referral day 1. A computerized tomography showed a 12.7 × 6.5 × 8.3 cm mass causing urethral and rectal compression, ureteral dilation and hydronephrosis. A vaginal leiomyoma was diagnosed on histology. As serum progesterone concentration kept increasing despite aglepristone treatment, a 0.02 ng/mL twice daily IM alfaprostol treatment was started on day 18. As neither treatment showed remission of clinical signs or luteolysis, ovariohysterectomy was performed on referral day 35. Multiple corpora lutea were found on both ovaries. On histology a luteoma was diagnosed on the left ovary. P4 levels were undetectable 7 days after surgery. Recovery was uneventful and 12 weeks after surgery tomography showed a reduction of 86.7% of the vaginal mass. The bitch has been in good health and able to urinate without any complication ever since.
CONCLUSIONS
This case demonstrates the importance of identifying progesterone related conditions as well as the importance of judiciously using a combined medical and surgical approach.
Topics: Animals; Dog Diseases; Dogs; Estrenes; Female; Hysterectomy; Leiomyoma; Luteoma; Ovarian Neoplasms; Ovariectomy; Progesterone; Prostaglandins F; Vaginal Neoplasms
PubMed: 32778114
DOI: 10.1186/s12917-020-02507-z