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Ovary - nontumor

Non-neoplastic cysts/other

Pregnancy luteoma


Reviewer: Shahid Islam, M.D., (see Reviewers page)
Revised: 5 June 2012, last major update June 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.

General
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● Single or multiple nodules of luteinized cells with abundant eosinophilic cytoplasm, detected during pregnancy
● Rare (100 cases described), probably hyperplasia due to hCG, not neoplasia
● 80% in multiparous women, 80% in blacks
● Usually an incidental finding at cesarean section or post-partum tubal ligation
● 25% are associated with virilization in latter half of pregnancy, 2/3 of female infants of virilized mothers are virilized (note: usually placenta aromatizes androgens to estrogens); testosterone levels are 70x normal, elevated even in non-virilized patients

Case reports
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● 33 year old woman with luteoma presenting as ovarian torsion with rupture and intra-abdominal bleeding (Singapore Med J 2008;49:e78)
● 34 year old woman With prenatal diagnosis of female pseudohermaphroditism associated with bilateral luteoma of pregnancy (Hum Reprod 2002;17:821)

Treatment
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● None - tumors are benign and regress weeks after delivery (infarct like necrosis leads to scar)

Gross description
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● Soft, fleshy, circumscribed, yellow/orange nodules, hemorrhagic, may be very large
● 1/3 bilateral, 1/2 multiple, may see separate corpus luteum

Gross images
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Bilaterally enlarged ovaries


Multicentric and bilateral tumor

Micro description
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● Sharply circumscribed, rounded masses of polygonal cells with abundant pink cytoplasm containing little lipid (theca-lutein cells), round nuclei, variably prominent nucleoli, mild nuclear atypia
● 2-3 MF/10 HPF, scant stroma; may have colloid filled spaces

Micro images
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Various images


Several follicle-like spaces are present


The cells have abundant eosinophilic cytoplasm and regular, round nuclei with prominent nucleoli


Two mitotic figures are visible

Positive stains
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● Alpha-inhibin, cytokeratin, vimentin, CD99

Electron macroscopy description
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● Smooth ER, dispersed Golgi, tubular cristae in mitochondria (associated with steroid hormone producing cells)

Differential diagnosis
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● Large solitary luteinized follicular cyst of pregnancy and puerperium, hyperreactio luteinalis (bilateral enlargement of ovaries, multiple luteinized follicle cysts, associated with increased hCG levels e.g. in GTD, multiple gestations, fetal hydrops), corpus luteum of pregnancy (central cavity, convoluted border, cells have hyaline or calcified bodies)
● Also granulosa tumor, thecoma, steroid cell tumor (not usually in pregnant women, usually unilateral, more non-luteinized foci, more lipid, more nuclear atypia), melanoma (pigment present, S100+, HMB45+, alpha-inhibin negative)

End of Ovary - nontumor > Non-neoplastic cysts/other > Pregnancy luteoma


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