Ovary - nontumor - Corpus luteum cyst

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Ovary-nontumor

Non-neoplastic cysts / other

Corpus luteum cyst (CLC)

Reviewer: Mohiedean Ghofrani, M.D. (see Reviewers page)
Revised: 9 August 2011, last major update August 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● An ovarian cyst lined by luteinized granulosa and theca cells measuring at least 3 cm in diameter

Terminology
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● A “corpus luteum cyst” (CLC) must measure at least 3 cm in diameter
● Any smaller cyst lined by similarly luteinized granulosa and theca cells is a “cystic corpus luteum,” which is physiologic

Epidemiology
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● Usually occurs during reproductive years, at end of menstrual cycle, or during pregnancy
● Rarely found in neonates (Obstet Gynecol 1983;61:525) or following sporadic ovulation in postmenopausal women

Etiology
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● Probably due to abnormalities in release of anterior pituitary gonadotropins

Clinical features
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● May present as palpable adnexal mass or with symptoms related to increased estrogen production (e.g. isosexual precocity or pseudoprecocity, amenorrhea, postmenopausal bleeding or endometrial hyperplasia)
● May rupture, leading to abdominal pain, hemoperitoneum and exsanguination, especially in patients on anticoagulant therapy or with a bleeding diathesis

Prognostic factors
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● Most regress spontaneously within 2 months
● Persistence of a cyst suggests neoplasia and requires surgical evaluation

Case reports
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● Ruptured corpus luteum cyst of pregnancy causing massive hemoperitoneum (J Pediatr Adolesc Gynecol 2007;20:97)
● Spontaneous rupture of hemorrhagic corpus luteum cyst torsion (Kaohsiung J Med Sci 2003;19:75)

Treatment
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● Observation of corpus luteum cysts <6 cm in women of reproductive age is justified
● Regression can be accelerated with a high dose of combination estrogen and progesterone
● Symptomatic cases may be treated by cyst puncture or may require surgical removal

Gross description
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● Usually single, thin-walled and unilocular, measuring 3-8 cm, but may be larger
● Convoluted yellow lining
● Fluid may be serous to serosanguinous to bloody

Gross images
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Corpus lutuem and corpus luteum cysts

Cyst is full of blood, probe at bottom right indicates point of rupture (AFIP)

Wall is thick and yellow and lining is smooth (AFIP)

Micro description
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● Convoluted lining composed of large, luteinized granulosa cells and an outer layer of smaller, luteinized, theca interna cells with a prominent inner layer of connective tissue
● Pregnant patients have hyaline bodies and calcific foci within granulosa cells

Micro images
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Corpus luteum-hemorrhagic

Layer of luteinized granulosa cells with abundant cytoplasm overlying small theca cells (AFIP)

Differential Diagnosis
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Other types of ovarian cysts are distinguished by the type of lining cells:
● Follicular cysts have a lining that is not as strikingly luteinized
● Surface epithelial inclusions, cysts and neoplasms are lined by serous, endometrioid, mucinous or transitional epithelium
● Epidermoid cysts are lined exclusively by mature, squamous epithelium
● Endometriotic cysts are lined by endometrial epithelium, stroma and pigmented histiocytes
● Simple cysts have no distinctive lining
● When ruptured, may be difficult to distinguish a CLC from endometriosis or ruptured ectopic pregnancy

End of Ovary-nontumor > Non-neoplastic cysts / other > Corpus luteum cyst

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