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Pregnancy Luteoma

Leyla Azmoun, MD
Donald DiSalvo, MD

March 28, 1996

Presentation

A 31-year-old G6P3 woman with a prior history of blighted ovum and intrauterine fetal demise presented with abdominal pain and a positive urine pregnancy test.

Imaging Findings

Images 1 & 2: Initial pelvic ultrasonography
Images 3 & 4: Follow-up study 5 months later
Image 5: Follow-up after an additional 2 weeks

Initial pelvic ultrasound reveals an intrauterine gestational sac which is somewhat eccentric (arrow). Right ovary is normal, containing a 1.5mm cyst (arrow)(most likely a corpus luteal cyst).

An obstetrical ultrasound performed 5 months later for size-date discrepancy shows a gravid uterus in the third trimester of pregnancy (see image #3). In the right adnexa, there is a predominantly solid mass (arrow), measuring 5.7 x 5.4 x 5.1 cm, with some posterior enhancement.

Repeat ultrasound two weeks later reveals enlargement of the solid mass (arrows) which now measures 8.7 x 8.1 x 6.6 cm.

Diagnosis

Pregnancy luteoma

Discussion

Pregnancy Luteoma is a non-neoplastic lesion characterized by ovarian enlargement during pregnancy which can simulate a tumor. It is characterized by replacement of the normal ovarian parenchyma by solid proliferation of luteinized stromal cells under the influence of human chorionic gonadotropin. Unlike the clinical scenario of gestational trophoblastic disease, patients with pregnancy luteoma do not have excessively high hcG levels; and within the ovary, it is the stromal cells rather than the follicles which are being stimulated. Since stromal cells produce androgen, virilization of mother and fetus can occur.

Pregnancy luteoma is most commonly seen in black, multiparous women in their third or fourth decade. It is often asymptomatic and is discovered incidentally at term during cescerian section.

Pregnancy luteoma usually appears as bilateral, multinodular solid masses in both ovaries. It is a benign self-limited condition and requires no treatment. Approximately 100 cases have been reported in the literature.

References

1. Kurman R. Blaustein's pathology of the female genital tract. 3rd edition. New York: Springer-Verlag, 1987:495-7.

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