Luteoma of pregnancy: sonographic findings in two cases.

Abstract

Luteoma of pregnancy is a rare nonneoplastic tumor-like mass of the ovary that emerges during pregnancy and regresses spontaneously after delivery. It is usually asymptomatic and is found incidentally during a cesarean section or postpartum tubal ligation. However, luteomas can be hormonally active, with production of androgens resulting in maternal and fetal hirsutism and virilization. Less than 200 cases have been described in the literature, and none in radiologic journals. Recognition of this entity is important so that unnecessary oophorectomy, with concomitant risk to both the patient and the fetus, is avoided. In this report, we describe two cases of luteoma of pregnancy. The first case documents sequential ultrasonographic demonstration of a presumed luteoma of pregnancy in a patient who was seen with hirsutism during a second trimester pregnancy. The luteoma, serum androgen levels, and patient's condition improved after delivery. This case is unique in that although the mass significantly decreased in size post partum, it continued to be visualized 14 months post partum. The second case illustrates the pronounced cystic appearance that these classically described solid lesions can demonstrate because of extensive necrosis.

Gravidez e disfunção lacrimal

“…Entretanto, embora os níveis totais de testosterona estejam aumentados durante a gravidez, deve-se levar em conta que existe, também, aumento concomitante da proteína ligadora desse hormônio (SHBG ou Serum Binding Sexual Hormones), que faz com que a fração livre e biologicamente ativa do hormônio seja bem mais baixa do que o esperado 11,12 . Além disso, tem sido descrito que níveis altos de progesterona contribuem para a sua redução de atuação, uma vez que existe competição entre progesterona e andrógenos pela ligação em receptores celulares 11,13 .…”

Imaging of Adnexal Masses in Pregnancy

“…15,16 They are thought to result from elevated plasma androgens after stromal cell proliferation during pregnancy and to involute postpartum with falling androgen levels. 14,15 On sonography, they appear as heterogeneous solid masses, predominantly hypoechoic compared with normal ovarian tissue, with thick walls and irregular internal contours in an enlarged ovary ( Figure 13). 14,15 They are often highly vascular and mimic ovarian neoplasms.…”

“…14,15 On sonography, they appear as heterogeneous solid masses, predominantly hypoechoic compared with normal ovarian tissue, with thick walls and irregular internal contours in an enlarged ovary ( Figure 13). 14,15 They are often highly vascular and mimic ovarian neoplasms. 14 The appearance of virilizing symptoms in the pregnant patient leads to this diagnosis.…”

“…14,15 They are often highly vascular and mimic ovarian neoplasms. 14 The appearance of virilizing symptoms in the pregnant patient leads to this diagnosis. When a luteoma is suspected, laparotomy can be avoided during pregnancy because the lesions regress after delivery.…”

“…Fewer than 200 cases of luteoma have been reported in the literature. 14 Luteomas cause maternal virilization in 25% to 30% of cases and carry a 50% risk of virilizing a female fetus. 15,16 Luteomas are usually asymptomatic and are found incidentally at cesarean delivery.…”