Introduction
Less than 200 occurrences of pregnancy luteoma, a rare non-neoplastic tumor-like lesion of the ovary, have been documented in the literature to date. It was initially described by Sternberg and Barclay in 1966. It is typically unintentionally found during postpartum tubal ligation or a cesarean operation. Most instances end entirely after delivery. A precise diagnosis is crucial for the mother and the fetus because it can be mistaken for ovarian cancer, which could result in an unwarranted oophorectomy and associated risks for both parties.
What Is Luteoma of Pregnancy?
Pregnancy luteomas are benign lutein-like cell tumors that can range in size from microscopic to more than 20 cm. Rarely, torsion from large luteomas can produce excruciating abdominal pain. When luteomas are examined closely, their cut surfaces show hemorrhagic foci and are firm, soft, tan, or flesh-colored.
Under the microscope, luteomas are finely defined nodules made of polygonal cells grouped into sheets, cords, or tiny clusters, or they might form follicles that contain material that resembles colloid. The cytoplasm is coarsely granular, eosinophilic, and plentiful. Predisposing factors for the formation of luteomas in pregnant women include certain medical disorders. Of these, polycystic ovarian syndrome is one. Pregnancy luteoma appears to be predisposing to polycystic ovarian syndrome due to elevated hormone levels. A mother's advanced age and repeated pregnancies are additional risk factors linked to luteomas.
The risk of developing another luteoma is increased in women who have already had one during a prior pregnancy. Pregnant women rarely develop malignant ovarian neoplasms. In the appropriate clinical context, observing an adnexal lesion consistent with luteoma in the brief postpartum period could be considered, as luteomas regress spontaneously following a decline in chorionic gonadotropin following delivery. After two to three weeks of giving birth, the ovaries and serum testosterone levels often return to normal.
What Are the Distinct Features of Luteoma in Pregnancy?
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Pregnancy luteomas are proliferations of non-neoplastic (hyperplastic) luteinized cells that normally arise during pregnancy.
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Decline on its own after delivery.
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Diffuse layers of round cells with plenty of eosinophilic cytoplasm and small nuclei are among the microscopic characteristics.
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Rapid mitosis may be seen in some luteomas.
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This could be a diagnostic hazard, particularly in intraoperative assessment.
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In these situations, the key to diagnosis is the presence of uniform, bland cells despite a supporting clinical history and a high mitotic rate.
What Is the Pathophysiology of Luteoma in Pregnancy?
Due to the discovery of elevated hCG (human chorionic gonadotropin) levels among luteoma patients, as well as their spontaneous remission following pregnancy, elevated hCG was previously linked as a direct causal agent of luteomas. Because luteinizing hormone (LH) and hCG share an alpha subunit, hCG can attach to the LH-hCG receptor on ovarian stromal cells, causing the cells to proliferate and become luteinized. Factors that prevent hCG from being the only cause in the pathophysiology of luteoma include elevated hCG levels present in other, more prevalent disorders (such as trophoblastic tumors); luteomas have not been linked to trophoblastic tumors.
What Is the Histopathology of Luteoma in Pregnancy?
Even in cases where there are several nodules, the lesion is well-defined and distinct from the surrounding tissue. There are sheets of cells. Periodically, stromal edema may cause cell clusters to separate, producing the appearance of ambiguous nesting. Follicle-like spaces could result in a look similar to that of a thyroid or, in more minor cases, an acinus.
A hazy reticular or nested pattern may occasionally be observed. Round to oval in shape, the cells contain round nuclei with prominent nucleoli and an abundance of eosinophilic cytoplasm. Occasionally, the cytoplasm of the cells is pale and foamy, and the nuclei are uniform (no nuclear pleomorphism).
Necrosis is uncommon but occasionally observed in very large tumors in a central area as a result of tumor infarction as they expand beyond their blood supply. Stroma is typically sparse; in certain instances, stromal fibrosis or edema may be visible, leading to an unclearly nested configuration of tumor cells. Certain authors have reported Granulosa cell proliferation of pregnancy in ovaries free of pregnancy luteoma.
What Are the Clinical Features of Luteoma in Pregnancy?
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Usually asymptomatic, with the lump only discovered by chance after a tubal ligation or cesarean delivery toward the conclusion of the pregnancy
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Pelvic masses are uncommon and rarely impede the birth canal.
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Virilization is observed in 25% of individuals, usually first appearing or worsening during the third trimester of pregnancy.
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There is a 70-fold rise in androgen levels over average.
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The androgen-blunting impact of sex hormone-binding globulin (SHBG) explains why women with high levels of androgen may not show signs of virilization.
Conclusion
Pregnancy luteoma is a rare illness that most likely results from a unique response to the changing hormonal milieu during pregnancy. Pregnant women rarely develop malignant ovarian neoplasms. Since luteomas regress spontaneously after a decline in chorionic gonadotropin post-delivery, an adnexal lesion similar to luteoma in the short-term postpartum period might be explored in the appropriate therapeutic setting. At about two to three weeks postpartum, the ovaries and serum testosterone levels typically recover. These pose a diagnostic and therapeutic issue since they might mimic the symptoms of malignant ovarian tumors. When there is an elevated clinical suspicion of pregnant luteoma, conservative treatment is recommended because these tumors typically resolve spontaneously.
