DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20181784

Hyperreactio luteinalis: benign disorder masquerading as an ovarian malignancy

Kaur P. P., Ashima ., Isaacs R., Goyal S.

Abstract


Hyperreactio luteinalis (HL) refers to pregnancy related moderate to marked enlargement of the ovaries due to multiple benign theca lutein cysts. It is caused due to elevated Human chorionic gonadotropins leading to maternal complications such as preeclampsia and preterm delivery may result. We report case of a 24 years old lady, G3P1A1L1 with spontaneous twin pregnancy at 13 weeks + 4 days gestation presented with chief complaint of lower abdominal pain on exertion for 5 days. Ultrasonography (USG) showed a large left ovarian mass in Pouch of Douglas pushing uterus up and extending into the left side of midline upto costal cartilage. It showed multiple thick septations with vascularity pointing towards malignancy. CA-125 was elevated to 193U/ml. Laparotomy was undertaken. Intraoperatively, bilateral huge, congested, bosselated, multicystic ovarian masses were present which replaced normal ovaries and appeared malignant. Bilateral oophorectomy was done. Specimens received for histopathological examination comprised of two large multilobulated, dark brown, ovarian masses with intact glistening capsule. Serial sections through both the masses showed thin walled, multiloculated cysts with smooth inner lining, filled with thin clear to hemorrhagic fluid. On microscopic examination diagnosis of Hyperreactio luteinalis, bilateral ovarian masses were made. HL can be misinterpreted on USG or laparotomy as ovarian malignancy resulting in unnecessary surgical intervention.


Keywords


Enlarged ovaries, Hyperreactio luteinalis, Theca lutein cyst, Spontaneous twin pregnancy

Full Text:

PDF

References


Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Maternal physiology. In: Williams Obstetrics. 23rd Ed. New York, NY: McGraw-Hill Medical; 2009:107-135.

Abbas AM, Talaat E, Gamal E, Michael A, Hanna S, Ali MN. An unusal case of asymptomatic hyperreactio luteinalis present at cesarean section of a spontaneous singleton pregnancy. Middle East Fertility Society J. 2017;30(22):160-2.

Schnorr JA Jr, Miller H, Davis JR, Hatch K, Seeds J. Hyperreactio luteinalis associated with pregnancy: a case report and review of the literature. Am J Perinatol. 1996;13:95-7.

Amoah C, Yassin A, Cockayne E, Bird A. Hyperreactio luteinalis in pregnancy. Fertil Steril. 2011;95:242.

Scully RE, Young RH, Clement PB. Tumour like lesions. In: Rosai J, Sobin LH, editors. Atlas of Tumor Pathology. 3rd Ed. Washington DC: Armed Forces institute of Pathology. 1998:424-6.

Mehandru N, Harris J, Kalinkin O, Liguori A. J Clin Gynecol Obstet. 2017;6:41-4.

Jamal A, Alavi A, Moosavi S. Hyperreactio Lutenalis with early-onset HELLP syndrome: A case report. Bimonthly J Homozygous University Med Sci. 2016;19:457-61.

Foulk RA, Martin MC, Jerkins GL, Laros RK. Hyperreactio luteinalis differentiated from severe ovarian hyperstimulation syndrome in a spontaneously conceived pregnancy. Am J Obstet Gynecol. 1997;176:1300-2.

Haimov-Kochman R, Yanai N, Yagel S, Amsalem H, Lavy Y, Hurwitz A. Spontaneous ovarian hyperstimulation syndrome and hyperreactio luteinalis are entities in continuum. Ultrasound Obstet Gynecol. 2004;24:675-8.

Lynn KN, Steinkeler JA, Wilkins-Haug LE, Benson CB. Hyperreactio Lutenalis (enlarged ovaries) during the second and third trimesters of pregnancy: common clinical associations. J Ultrasound Med. 2013;32:1285-9.