Pregnancy Luteoma. One group of ovarian masses results directly from the stimulating efects of various pregnancy hormones on ovarian stroma. These include pregnancy luteoma, hyperreactio luteinalis, and ovarian hyperstimulation syndrome.
Of these, pregnancy luteoma is a rare, benign ovarian neoplasm that arises from luteinized stromal cells and classically causes elevated testosterone levels (Hakim, 2016; Irving, 2011). Up to 25 percent of afected women will be virilized, and of these afected women, nearly half of their female fetuses will have some degree of virilization. However, most mothers and their fetuses are unafected because the placenta rapidly converts testosterone to estrogen (KanovG, 2011).
In typical cases, an adnexal mass along with maternal virilization will prompt sonography and measurement of testosterone and CA125 levels. Luteomas range in size from microscopic to >20 cm. hey appear as solid tumors, may be multiple or bilateral, and may be complex because of internal hemorrhage (Choi, 2000). Concerns for malignancy may be further investigated with MR imaging (Kao, 2005; Tannus, 2009).
Total testosterone levels are increased, but notably, levels in normal pregnancy can be substantially elevated (Appendix, p. 1259). Diferential diagnoses include granulosa cell tumors, thecomas, Sertoli-Leydig cell tumors, Leydig cell tumors, stromal hyperthecosis, and hyperreactio luteinalis.
Generally, luteomas do not require surgical intervention unless there is torsion, rupture, or hemorrhage (Masarie, 2010). hese tumors spontaneously regress during the irst few months postpartum, and androgen levels drop precipitously during the irst 2 weeks following delivery (Wang, 2005). Lactation may be delayed a week or so by hyperandrogenemia (Dahl, 2008). Recurrence in subsequent pregnancies is rare.
Hyperreactio Luteinalis. In this condition, one or both ovaries develop multiple, large theca-lutein cysts, typically after the first trimester. Cysts are caused by luteinization of the follicular theca interna layer, and most are in response to stimulation by excep tionally high hCG levels (Russell, 2009). For this reason, they are more common with gestational trophoblastic disease, twins, fetal hydrops, and other conditions with increased placental mass. Maternal virilization may develop, but fetal virilization has not been reported (KanovG, 2011; Malinowski, 2015).
s reported by Baxi and coworkers (2014), these ovarian tumors appear sonographically to have a "spoke wheel" pattern (Fig. 20-3, p. 391). If the diagnosis is confident, and unless com plicated by torsion or hemorrhage, surgical intervention is not required. hese masses resolve ater delivery. Few data allow pre diction of risk in a subsequent pregnancy, but in one case report, a woman had hyperreactio with three pregnancies (Bishop, 2016).