Differential diagnosis of bilateral ovarian masses during pregnancy, and their hormonal effect

Tatsuo Masuda, Shinya Matsuzaki, Tsuyoshi Takiuchi, Masayuki Endo, Takuji Tomimatsu, Tadashi Kimura


Rapidly enlarging bilateral ovarian cystic masses can be confused with malignant entities. When this happens during pregnancy, benign transient reactivity can present a similar clinical course. Here we describe a 33-year-old woman with hyperreactio luteinalis or multiple gestational theca lutein cysts whose ovaries drastically changed in size peripartum, with concordant changes in human chorionic gonadotropin, thyroid function, and testosterone levels. Management was conservative and the cystic masses spontaneously remitted postpartum. Present work suggested that evaluating the character of the cysts by magnetic resonance imaging and serial assessments of their size and the patient’s hormonal levels may assist in diagnosis. Conservative management could be successfully applied in a carefully chosen subset of patients to avoid unnecessary invasive procedures.


Androgen, Hyperreactio luteinalis, Pregnancy, Thyroid hormone

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Mariam N, Anjali K. Adnexal Masses in Pregnancy. Clin Obstet Gynecol. 2015;58(1):93-101.

Webb KE, Sakhel K, Chauhan SP, Abuhamad AZ. Adnexal mass during pregnancy: a review. Am J Perinatol. 2015;32(11):1010-6.

Bernhard LM, Klebba PK, Gray DL, Mutch DG. Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol. 1999;93(4):585-9.

Minig L, Otaño L, Cruz P, Patrono MG, Botazzi C, Zapardiel. Laparoscopic surgery for treating adnexal masses during the first trimester of pregnancy. J Minim Access Surg. 2016;12(1):22-5.

Tanaka YO, Okada S, Sakata A, Saida T, Nagai M, Yoshikawa H, et al. A metastatic ovarian tumor mimicking pregnancy luteoma found during pueperium. Magn Reson Med Sci. 2016;15(2):149-50.

Abe T, Ono S, Igarashi M, Akira S, Watanabe A, Takeshita T. Conservative management of hyperreactio luteinalis: a case report. J Nippon Med Sch. 2011;78(4):241-5.

Gonçalves IS, Malafaia S, Belchior H, Tiago-Silva P. Hyperreactio luteinalis encountered during caesarean delivery of an uncomplicated spontaneous singleton pregnancy. BMJ case reports. 2015.

VanNagell JR, Miller RW. Evaluation and management of ultrasonographically detected ovarian tumors in asymptomatic women. Obstet Gynecol. 2016;127(5):848-58.

Yen CF, Lin SL, Murk W, Wang CJ, Lee CL, Soong YK, et al. Risk analysis of torsion and malignancy for adnexal masses during pregnancy. Fertil Steril. 2009;91(5):1895-902.

Takeuchi M, Matsuzaki K. Magnetic resonance manifestations of hyperreactio luteinalis. J Comput Assist Tomogr. 2011;35(3):343-6.

Li Q, Li X, Zhang P. Ovarian torsion caused by hyperreactio luteinalis in the third trimester of pregnancy: a case report. Int J Clin Exp Med. 2015;8(10):19612-5.

Simsek Y, Celen S, Ustun Y, Danisman N, Bayramoglu H. Severe preeclampsia and fetal virilization in a spontaneous singleton pregnancy complicated by hyperreactio luteinalis. Eur Rev Med Pharmacol Sci. 2012;16(1):118-21.

McClamrock HD, Adashi EY. Gestational hyperandrogenism. Fertil Steril. 1992;57(2):257-74.

Ugaki H, Enomoto T, Tokugawa Y, Kimura T. Luteoma-induced fetal virilization. J Obstet Gynaecol Res. 2009;35(5):991-3.