DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20200394

Hyperreactio leuteinalis: benign tumour associated with pregnancy mimicking ovarian malignancy

Nazli Tarannum, Nishat Akhtar

Abstract


Hyperreactio leuteinalis refers to pregnancy related enlargement of B/L ovaries rarely unilateral ovary, moderate to marked size due to multiple theca leutein cysts. It is a rare finding associated with pregnancy seen commonly in multiple gestation, GTDs and fetal abnormalities: viz hydrops. It is caused by elevated B-hcg level. We report a case of 28 years old female, primi with 13 spontaneously conceived weeks pregnancy who presented to ANC OPD for regular check-up and vague abdominal discomfort. USG revealed a large right sided ovarian mass, solid cystic in appearance pushing the uterus to left side and upwards. Staging laparotomy was done at 14 weeks viewing it to be a malignant mass. Unilateral right sided oophorectomy was done along with biopsy taken from left ovary. On microscopic histological examination diagnosis of hyperreactio leuteinalis unilateral ovary was made. Hyperreactio leuteinalis mimicking ovarian malignancy on USG results in unnecessary surgical intervention.


Keywords


Elevated B-hcg level, Solid cystic ovarian mass, Oophorectomy, Pregnancy related

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References


Taylor HS, Pal L, Sell E. Speroff. Clinical Gynecologic Endocrinology and Infertility. Normal and Abnormal Sexual Development. 9th edition. Wolters Kluwer; 2019:363-364.

Hoffman BL. Pelvic Mass. Williams Gynecology. 3rd ed. New York, NY: McGraw-Hill; 2016:266.

Van Holsbeke C, Amant F, Veldman J, De Boodt A, Moerman P, Timmerman D. Hyperreactio luteinalis in a spontaneously conceived singleton pregnancy. Ultrasound Obstet Gynecol. 2009;33(3):371-3.

Cavoretto P, Giorgione V, Sigismondi C, Mangili G, Serafini A, Dallagiovanna C, et al. Hyperreactio luteinalis: timely diagnosis minimizes the risk of oophorectomy and alerts clinicians to the associated risk of placental insufficiency. Eur J Obstet Gynecol Reprod Biol. 2014;176:10-6.

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(6):1300-2.

Gherman RB, Mestman JH, Satin AJ, Goodwin TM. Intractable hyperemesis gravidarum, transient hyperthyroidism and intrauterine growth restriction associated with hyperreactio luteinalis: a case report. J Reprod Med. 2003;48:553.

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;78:241-5.

Hashmi HA, Tufail A. Hyperreatio luteinalis in association with molar pregnancy. Pak J Surg. 2008;24:140-2

Cho AR, Song TB, Kim HJ, Kim YH, Kim JW. Vaginal delivery in a spontaneously conceived singleton pregnancy complicated with hyperreactio luteinalis: a case report. J Womens Med. 2011;4:53-6.

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