Hyperreactio luteinalis in a spontaneously conceived singleton pregnancy

• DOI: 10.1002/uog.6325
• Publication Date: 2009-02-26T10:26:25Z
• Authors: C. Van Holsbeke; F. Amant; J. Veldman; A. De Boodt; Ph. Moerman; D. Timmerman
• Keywords: Adnexal mass

Hyperreactio luteinalis is a rare condition in pregnancy that caused by high β-human chorionic gonadotropin (β-hCG) levels or abnormal sensitivity of the β-hCG receptor. It mostly seen patients with trophoblastic disease, multiple after fertility treatment. We describe our imaging findings and management case hyperreactio diagnosed singleton spontaneously conceived pregnancy. A 28-year-old primigravida was referred to gynecological ultrasound department University Hospitals, Leuven, for evaluation bilateral adnexal masses at 14 weeks' gestation. Her had been she no personal family history ovarian, breast colon cancer. There subfertility patient did not use any kind medication. The were first visualized regional hospital when presented emergency room abdominal pain. Vaginal examination revealed large mobile filled pouch Douglas. Transabdominal transvaginal gray-scale color Doppler performed using GE Voluson E8 Expert scanner (4–8-MHz transabdominal transducer 6–12-MHz (GE Healthcare Technologies, Milwaukee, WI, USA)). Large multilocular measuring 141 × 134 103 mm (volume, 1019 cm3) left ovary 127 120 87 694 right visualized. Both contained more than 10 locules rather thick (>3 mm) septa anechoic cyst fluid. wall regular (Figure 1) score 3 (moderately vascularized) both masses. fetus normal size gestational age structural abnormalities small quantity free fluid Douglas (30 22 but ascites. an X-ray chest negative metastases pleural effusion. Blood analysis showed raised level serum CA-125 442 kU/L. Gray-scale images extended field view mode, showing one uterus containing 14-week sagittal (a) axial (b) views luteinalis. Owing progressive growth masses, reaching diaphragm, number locules, suspected be mucinous borderline tumors intestinal type surgery. Surgery 18 weeks gestation midline incision. mass reached liver entire paracolic area 2). ascites macroscopic signs metastases. adnexectomy and, on frozen section, intraoperative diagnosis 3). punctured situ. Postoperative recovery subsequent course uneventful. spontaneous vaginal delivery 3800-g girl 40 weeks. At 9 postpartum, asymptomatic adnexa hemorrhagic corpus luteum cyst. Intraoperative luteinalis, fundus uteri. Microscopic leading (original magnification 250). can occur stage pregnancy, typically third trimester1. In almost all cases it triggered very endogenous exogenous stimulation2. Therefore most publications report presence molar association choriocarcinoma fetal hydrops, An abnormally rapid rise trimester hCG receptor due gene mutation lead exceptional pregnancy3. Burger described associated since few have reported pregnancies4-6. Depending either are they present pain intra-abdominal pressure, torsion intracystic hemorrhage. Virilization hyperandrogenism as many 25% affected patients7, 8. Symptoms hyperemesis gravidarum hyperthyroidism usually related provoked underlying problem causing (trophoblastic pregnancy). prognosis this benign good postpartum period theca lutein cysts regress spontaneously7. sustained induces development cysts. Hypertrophy luteinization granulosa interna layer typical microscopic features 3)9. On characterized consist thin-walled cysts, giving appearance 'spoke wheel'. Ascites present. their morphology hard distinguish from ovarian hyperstimulation syndrome (OHSS)4, 5, 7, 8, 10. OHSS exclusively occurs following treatment although, rarely, pregnancies. By contrast presents beginning severe symptoms involving acute imbalances impair natural course5. With even mimic malignancy, particular tumor type, unnecessary surgery8. However, compared smaller round tend less solid tissue Frédéric Amant clinical researcher Research Fund–Flanders (FWO–Vlaanderen).