Luteomas of pregnancy

Pregnancy luteoma: a study of 20 cases on the occasion of the 50th anniversary of its description by Dr. William H. Sternberg, with an emphasis on the common presence of follicle-like spaces and their diagnostic implications

Twenty cases of the distinctive tumor-like lesion of the ovary, pregnancy luteoma, are described, with emphasis on pathologic features. The masses occurred in patients from 15 to 44 years of age and were typically incidental findings at or near term. Four patients experienced androgenic manifestations. The luteoma was documented to be bilateral in only 4 cases, but the opposite ovary was usually not evaluated pathologically. They ranged up to 15 cm. Sectioning typically showed multiple nodules or a single discrete mass with a multinodular sectioned surface and a soft bulging appearance. Most lesions were brown, but a few were black or yellow at least focally. Foci of hemorrhage were common. The most common microscopic appearance was a diffuse growth, but it was punctuated in about three quarters of the cases by follicle-like spaces often containing colloid-like secretion. These spaces are much more characteristic of the pregnancy luteoma than of the lesion most often in the differential diagnosis, a steroid cell tumor, and accordingly may be of diagnostic aid. However, they may cause confusion, as follicle-like spaces are a nonspecific feature of a number of neoplasms involving the ovary and potentially in the differential diagnosis. Awareness of the clinical background and frequency of finding follicle-like spaces in pregnancy luteoma are important diagnostically, and standard immunohistochemical stains will aid should they be warranted.

Incidental pregnancy luteoma associated with ectopic tubo-ovarian pregnancy: evidence in favor of origin from theca interna of an atretic follicle

An incidental pregnancy luteoma was identified microscopically in an ovary submitted for ruptured ectopic tubo-ovarian pregnancy. The lesion consisted of a localized, non-encapsulated proliferation of thecal cells in the wall of an atretic follicle and had all the pathologic features of the typical late pregnancy luteoma. This finding is presented to support the origin of the pregnancy luteoma from the theca interna of atretic follicles.

Androluteoma syndrome of pregnancy

The clinical course of a 26-year-old primigravid woman with a virilizing luteoma of pregnancy is described. It was demonstrated by endocrine studies that the tumor secreted an excessive amount of testosterone. After removal of the luteoma in week 32 of pregnancy, the virilizing symptoms of the mother completely regressed. A normal male infant was delivered in week 39. From 100 luteomas of pregnancy described in the literature, 26 cases have been cited to elicit endocrine virilizing activity. An evaluative synopsis indicates that including the case described in this paper only 13 can be regarded as a clinical, morphologic, and functional entity. This entity should be differentiated from the inhomogeneous group of luteomas as the "androluteoma syndrome of pregnancy." It is characterized by the following major criteria: virilization, beginning with the second trimester of pregnancy; histologic criteria of a luteoma of pregnancy; production of testosterone, leading to excessive plasma levels (exceeding the concentration of androstenedione), and masculinization of female fetuses.

Luteoma of pregnancy: ultrastructural features

The ultrastructural configuration of the cells in one case of pregnancy luteoma was studied by conventional electron microscopy. The fine structure of these cells conforms closely to that of steroid hormone producing cells in other human organs, such as the adrenal cortex, testicular interstitium, and corpus luteum, particularly in terms of the presence of abundant smooth endoplasmic reticulum, dispersed Golgi apparatus, and tubular cristae in the mitochondria. Similarities were noted between the pregnancy luteoma cells and, as described by other authors, the luteinized granulosa and theca cells of the human corpus luteum and the cells of spontaneous mouse luteoma. There was a more pronounced resemblance to the granulosa cells of the corpus lutemum than to the luteinized theca cells or the mouse luteoma cells but with considerable overlap among all of them. Distinctive features, not previously described, were noted in the pregnancy luteoma cells in the form of deep cytoplasmic invaginations of the cell membrane closed by tight junctions, and peculiar pleated sinuous membranous arrays within the cytoplasm. The significance of these structures is not known. In addition mesenchymal cells of ambiguous differentiation were noted in the stroma of the tumor, suggesting that the stimulus to luteinized cell proliferation may transcend the specific ovarian mesenchymal cells and may also be exerted on the supporting stroma. On the basis of previous reports concerning the biochemical and biosynthetic patterns of sex steroid hormone production by these tumors, it is concluded that although the latter recapitulate the endocrine functions of the normal ovarian stroma rather than those of the corpus luteum, the cytoarchitecture of these tumors covers a much broader spectrum of differentiation, which may come to resemble closely although not exclusively that of luteinized granulosa cells.