Hirsutism Caused by Pregnancy Luteoma in a Low-Resource Setting: A Case Report and Literature Review

Abstract

Background. Pregnancy luteomas are rare, benign, ovarian neoplasms resulting from increased androgenic activity during pregnancy. Often, they occur asymptomatically and are only diagnosed incidentally during imaging or surgery: cesarean section or postpartum tubal ligation. Most common symptoms associated with pregnancy luteoma include acne, deepening of voice, hirsutism, and clitoromegaly. Most pregnancy luteomas regress spontaneously postpartum. Thus, the management of pregnancy luteomas depends on the clinical situation. Case. We report a case of 28-year-old gravida 2, para 1 who presented at 39 + 1 weeks of gestation with prolonged labor and delivered by emergency cesarean. Intraoperatively, a huge left ovarian mass was identified and resected, and tissue was sent for histopathology and a diagnosis of pregnancy luteoma was made after the pathological report. Conclusion. The present report emphasizes that pregnancy luteoma is a benign neoplasm and imprudent surgical intervention should be reserved. Proper imaging techniques, preferably MRI or ultrasonography that visualize the size of the ovary and reproductive hormonal profiles, would suffice for the diagnosis and management of pregnancy luteoma.

Luteoma of Pregnancy Presenting as Ruptured Ectopic Pregnancy: A Case Report

“…These tumors rarely present in early pregnancy [5]. As these lesions are benign and regress spontaneously after pregnancy once the pregnancy-associated hormonal changes revert back, only patients with virilizing symptoms or complications such as torsion require immediate surgery [5]. Our patient did not have any features of virilization or torsion but warranted surgery as it was a case of ruptured luteoma of pregnancy.…”

“…There can be a variety of differential diagnoses for luteoma of pregnancy, ranging from benign to malignant. Corpus luteoma of pregnancy is an important differential diagnosis as an ovarian mass seen in early pregnancy [1], but it shows a histopathological architecture of convoluted folds arranged around a fibrovascular center forming its core [5]. Another common benign differential is hyperreactio luteinalis, but it is more cystic and mostly involves bilateral ovaries [1].…”

“…Among the malignant ovarian masses, steroid cell tumors form a very close differential, in that they also present with features of virilization, but they have a distinct vascular structure on microscopic examination, which helps in differentiation [1]. Luteinized granulosa cell tumors and thecomas have non-luteinized cells on microscopy [5].…”

“…Luteoma of pregnancy should be suspected in patients with underlying polycystic ovarian syndrome (PCOS), as PCOS predisposes to increased beta hCG levels, thus increasing the risk of the formation of luteoma of pregnancy [4,8]. These tumors rarely present in early pregnancy [5]. As these lesions are benign and regress spontaneously after pregnancy once the pregnancy-associated hormonal changes revert back, only patients with virilizing symptoms or complications such as torsion require immediate surgery [5].…”

“…This rare ovarian lesion was first described by Sternberg and Barclay in 1966 [2]. Luteoma has been found mostly associated with maternal or fetal virilization [3][4][5]. Most commonly, it is found incidentally on imaging or during cesarean delivery/postpartum tubal ligation [2].…”