Cases reported "luteoma"

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1/12. pregnancy luteoma with granulosa cell proliferation: an unusual hyperplastic lesion arising in pregnancy and mimicking an ovarian neoplasia.

    A pregnancy luteoma (PL) was incidentally found at a term cesarean section in a 27-year-old black woman without any endocrine abnormality. The lesion involved only the left ovary; it had a nodular and focal pseudoalveolar growth pattern and was associated with areas of tubular sertoliform component, consistent with granulosa cell proliferation. immunohistochemistry revealed a diffuse positivity to Inhibin A, CD99, cytokeratin and vimentin. The ultrastructure was typical of steroid-producing cells. PL is a tumor-like lesion arising in pregnant women and often misdiagnosed as a neoplastic lesion; awareness of this rare entity and its differential diagnoses may avoid unnecessary surgery in young patients. ( info)

2/12. Bilateral krukenberg tumor of the ovary during pregnancy.

    This case report concerns a 35-year-old woman suffering from gravidic cholestasis, thrombocytosis and iterative vomiting episodes who underwent an elective cesarean section at week 35 because of recent herpetic vulvitis. Large bilateral ovarian tumors were observed which were interpreted as pregnancy luteomas. Nevertheless a biopsy of the right ovary was performed. Histologic examination revealed massive luteinization of the ovarian stroma. In addition, large tumor cells were found dispersed throughout the ovary as well as in vascular spaces as either isolated or clustered signet-ring cells. In search of the primary tumor, gastroscopy revealed a gastric ulcer in the antrum. The biopsies of the ulcer margins as well as those taken at distance demonstrated signet-ring cells in the lamina propria. Bilateral salpingo-oophorectomy and total gastrectomy were performed. In spite of postoperative chemotherapy, the patient died of disease 5 months after diagnosis. ( info)

3/12. Congenital adrenal hyperplasia associated with maternal pregnancy luteoma and the Antley-Bixler syndrome.

    The authors report on a child with indifferent external genitalia consisting of severe micropenis with penile urethra leading to the tip of the glans and bilateral cryptorchidism. Diagnostic workup findings showed a female karyotype, homozygous 21-hydroxylase deficiency, and excessive testosterone exposure prenatally as a consequence of maternal pregnancy luteoma, altogether causing this unusual phenotype. In addition, the girl suffered from skeletal anomalies consistent with the diagnosis of Antley-Bixler syndrome. Our case shows that, although the association of congenital adrenal hyperplasia with other syndromes is rare, and even if other possible reasons for in utero virilization are present, complete diagnostic workup including karyotyping and hormonal status should be done in all patients with ambiguous genitalia, especially in cases of an unusual phenotype. The authors report on the diagnostic procedures and discuss the surgical approach in this particular case, never described before in the literature. ( info)

4/12. Sudden death from trophoblastic embolism in pregnancy.

    A case of a 24-year-old multigravida, with dry cough, dyspnea, fatigue, and weight loss with normal foetal growth rate is reviewed. Upon admission the patient suddenly became tachycardic, tachypnoic, cyanotic, followed by a non-palpable peripheral pulse, and asystole unresponsive to resuscitation. The autopsy revealed massive pulmonary trophoblastic embolism, bilateral pregnancy luteoma, and accelerated placental maturation. Trophoblastic embolism should be taken into consideration whenever cardiorespiratory emergency develops during pregnancy. ( info)

5/12. luteoma of pregnancy: sonographic findings in two cases.

    luteoma of pregnancy is a rare nonneoplastic tumor-like mass of the ovary that emerges during pregnancy and regresses spontaneously after delivery. It is usually asymptomatic and is found incidentally during a cesarean section or postpartum tubal ligation. However, luteomas can be hormonally active, with production of androgens resulting in maternal and fetal hirsutism and virilization. Less than 200 cases have been described in the literature, and none in radiologic journals. Recognition of this entity is important so that unnecessary oophorectomy, with concomitant risk to both the patient and the fetus, is avoided. In this report, we describe two cases of luteoma of pregnancy. The first case documents sequential ultrasonographic demonstration of a presumed luteoma of pregnancy in a patient who was seen with hirsutism during a second trimester pregnancy. The luteoma, serum androgen levels, and patient's condition improved after delivery. This case is unique in that although the mass significantly decreased in size post partum, it continued to be visualized 14 months post partum. The second case illustrates the pronounced cystic appearance that these classically described solid lesions can demonstrate because of extensive necrosis. ( info)

6/12. prenatal diagnosis of female pseudohermaphroditism associated with bilateral luteoma of pregnancy: case report.

    female pseudohermaphroditism associated with luteoma of pregnancy (LP) is a rare condition characterized by varying degrees of masculinization of a female fetus. We describe a case, diagnosed at 13 weeks gestation. Transvaginal ultrasound at 5 weeks of gestation revealed a normal intrauterine gestational sac and an enlarged maternal right ovary. Re-examination at 13 weeks showed a fetus with male external genitalia. Cytogenetic investigation on amniotic fluid revealed a normal female karyotype 46,XX. Follow-up sonography confirmed the previous assignment of male external genitalia and a second amniocentesis was negative for the SRY gene. High levels of androgens were found in the maternal blood. A diagnosis of female pseudohermaphroditism associated with bilateral LP was made. A healthy girl was born by Caesarean section with complete masculinization of external genitalia (Prader V). histology confirmed a bilateral LP. To the best of our knowledge this represents the first case of prenatal diagnosis of female pseudohermaphroditism associated with LP and demonstrates the feasibility of diagnosis by sonography from 13 weeks gestation. This is also the first case described of Prader V masculinization associated with LP. ( info)

7/12. magnetic resonance imaging of pregnancy luteoma.

    We present the magnetic resonance (MR) imaging findings of pregnancy luteoma in an asymptomatic woman at 32 weeks of gestation. MR imaging with a half-Fourier, single-shot, turbo spin-echo sequence showed multilocular cystic masses with thickened internal septa in bilateral adnexa. The MR findings were similar to those of other cystic tumors or tumor-like lesions of the ovary. ( info)

8/12. MR imaging of pregnancy luteoma: a case report and correlation with the clinical features.

    We report here on a 26-year-old pregnant female who developed hirsutism and virilization during her third trimester along with a significantly elevated serum testosterone level. Abdominal US and MR imaging studies were performed, and they showed unique imaging features that may suggest the diagnosis of pregnancy luteoma in the clinical context. After the delivery, the serum testosterone level continued to decrease, and it returned to normal three weeks postpartum. The follow-up imaging findings were closely correlated with the clinical presentation. ( info)

9/12. Maternal and female fetal virilization caused by pregnancy luteomas.

    OBJECTIVE: To present the maternal and female fetal virilization caused by excessive androgen secretion of pregnancy luteomas. DESIGN: Case report. SETTING: University-based teaching hospital. PATIENT(S): A nulligravida woman suffering from bilateral hydronephrosis and recurrent acute pyelonephritis caused by bilateral solid ovarian tumors presented virilization during the third trimester. Without prompt surgical intervention, the maternal hyperandrogenemia returned to a normal level and regression of bilateral ovarian tumors occurred spontaneously after a female fetus with clitoral hypertrophy and temporal hyperandrogenemia was delivered. In spite of lacking histology, the clinical course is compared to that of pregnancy luteomas. INTERVENTION(S): Noninvasive imaging assessment. MAIN OUTCOME MEASURE(S): Maternal and female fetal virilization. RESULT(S): Regression of androgen-secreting pregnancy luteomas and hyperandrogenism during the puerperium but apparent female fetal clitoral hypertrophy. CONCLUSION(S): The maternal and female fetal virilization was caused by exaggerating androgen secretion of bilateral ovarian solid tumors. Spontaneous regression of ovarian tumors and hyperandrogenemia during the puerperium is the natural course of pregnancy luteomas, not true neoplasms. ( info)

10/12. Virilization during pregnancy with spontaneous resolution postpartum: a case report and review of the English literature.

    The incidence of gestational hyperandrogenism secondary to ovarian pathology is low. However, when the condition does exist, diagnosis should be made with minimally invasive modalities. It is important to provide appropriate medical/surgical intervention without disturbing the pregnancy iatrogenically or causing unnecessary maternal morbidity. This case report adds to the existing radiographic data concerning this rare obstetrical condition. Presented is a review of the English literature on virilizing ovarian tumors during pregnancy, and a discussion of an approach to managing these tumors when they occur during pregnancy. ( info)
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