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Mavrantoni I, Borneman R, Hittelman AB, Vash-Margita A. Impact of luteoma during pregnancy on fetal development and its long-term effects into adulthood. BMJ Case Rep 2024; 17:e259373. [PMID: 39117365 DOI: 10.1136/bcr-2023-259373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
A woman in her 30s presents to the Differences in Sexual Development Programme at a tertiary care academic medical centre with vaginal stenosis and scarring. Her medical history is significant for virilisation in utero due to a maternal luteoma of pregnancy. Laboratory investigations at the time of birth showed elevated androgens in both mother and daughter. During infancy, she underwent clitoroplasty and vaginoplasty for correction of posterior vaginal fusion. She represented as an adult with vaginal stenosis, with associated physical and psychosocial implications. She was not able to insert a tampon or have penetrative intercourse. After examination and shared decision-making, the patient underwent cystoscopy, vaginoscopy and posterior vaginoplasty with the goal to create a normal calibre vagina. Postoperative dilator use was recommended to prevent restenosis of the introitus. In clinic follow-up, the patient was observed to have a normal calibre vagina.
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Affiliation(s)
- Ioanna Mavrantoni
- Gastroenterology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Rebecca Borneman
- Obstetrics and Gynaecology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Alla Vash-Margita
- Section of Pediatrics and Adolescent Gynecology; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
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2
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Shang J, Huang C, Zheng Q, Feng J, He K, Xie H. Imaging features, clinical characteristics and neonatal outcomes of pregnancy luteoma: A case series and literature review. Acta Obstet Gynecol Scand 2024; 103:740-750. [PMID: 37710408 PMCID: PMC10993364 DOI: 10.1111/aogs.14672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION This study aimed to investigate the imaging features, clinical characteristics and neonatal outcomes of pregnancy luteoma. MATERIAL AND METHODS We retrospectively analyzed patients with pregnancy luteoma admitted to the First Affiliated Hospital of Sun Yat-sen University between January 2003 and December 2022. We recorded their imaging features, clinical characteristics and neonatal outcomes. Additionally, we reviewed relevant studies in the field. RESULTS In total, 127 cases were identified, including eight from our hospital and 119 from the literature. Most patients (93/127, 73.23%) were of reproductive age, 20-40 years old, and 66% were parous. Maternal hirsutism or virilization (such as deepening voice, acne, facial hair growth and clitoromegaly) was observed in 29.92% (38/127), whereas 59.06% of patients (75/127) were asymptomatic. Abdominal pain was reported in 13 patients due to compression, torsion or combined ectopic pregnancy. The pregnancy luteomas, primarily discovered during the third trimester (79/106, 74.53%), varied in size ranging from 10 mm to 20 cm in diameter. Seventy-five cases were incidentally detected during cesarean section or postpartum tubal ligation, and 39 were identified through imaging or physical examination during pregnancy. Approximately 26.61% of patients had bilateral lesions. The majority of pregnancy luteomas were solid and well-defined (94/107, 87.85%), with 43.06% (31/72) displaying multiple solid and well-circumscribed nodules. Elevated serum androgen levels (reaching values between 1.24 and 1529 times greater than normal values for term gestation) were observed in patients with hirsutism or virilization, with a larger lesion diameter (P < 0.001) and a higher prevalence of bilateral lesions (P < 0.001). Among the female infants born to masculinized mothers, 68.18% (15/22) were virilized. Information of imaging features was complete in 22 cases. Ultrasonography revealed well-demarcated hypoechoic solid masses with rich blood supply in 12 of 19 cases (63.16%). Nine patients underwent magnetic resonance imaging (MRI) or computed tomography (CT), and six exhibited solid masses, including three with multi-nodular solid masses. CONCLUSIONS Pregnancy luteomas mainly manifest as well-defined, hypoechoic and hypervascular solid masses. MRI and CT are superior to ultrasonography in displaying the imaging features of multiple nodules. Maternal masculinization and solid masses with multiple nodules on imaging may help diagnose this rare disease.
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Affiliation(s)
- Jian‐Hong Shang
- Department of Ultrasonic MedicineFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Cai‐Xin Huang
- Department of Ultrasonic MedicineFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Qiao Zheng
- Department of Ultrasonic MedicineFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Jie‐Ling Feng
- Department of Ultrasonic MedicineFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Ke He
- Department of Obstetrics and GynecologyFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Hong‐Ning Xie
- Department of Ultrasonic MedicineFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
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3
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Moran GW, Steinman JB, Tillotson CV, Carpenter CP, Hays T, Ham JN, Li B. Virilization of a 46,XX Fetus Following Aromatase Inhibitor Treatment of Breast Cancer. Pediatrics 2023:191231. [PMID: 37128841 DOI: 10.1542/peds.2022-060568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 05/03/2023] Open
Abstract
Virilization of the 46,XX infant may be attributed to maternal or fetoplacental origin. Maternal sources may be endogenous, as with an androgen-producing tumor, or drug-related. Iatrogenic virilization by maternal drug exposure is rarely reported, with individual case reports and case series demonstrating the effects of progesterone and other medications affecting the pituitary-ovarian axis.1-3 The class of medications known as aromatase inhibitors are recognized as effective in treating hormone receptor-positive breast cancer by preventing the conversion of androgens into estrogens by aromatase. In fetal development, placental aromatase plays a critical role in preventing virilization of the XX fetus by maternal and fetal androgens during development. In the setting of placental aromatase deficiency, the XX fetus may be virilized. It is conceivable, therefore, that maternal exposure to aromatase inhibitors early in gestation may lead to in utero virilization, though there have been no known reports of this phenomenon to date. We present a case of virilization of a 46,XX infant attributed to pharmacologic aromatase inhibition. The infant's parents provided informed consent for the reporting of this case.
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Affiliation(s)
| | - Jonathan B Steinman
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, and
| | - Cara V Tillotson
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, and
| | | | - Thomas Hays
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - J Nina Ham
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, and
| | - Belinda Li
- Division of Pediatric Urology, Department of Urology
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4
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Zhu L, Zhang D, Yang Y. A case of excision of ovarian torsion necrosis due to luteoma in a female who conceived a twin pregnancy through in vitro fertilization misdiagnosed with acute appendicitis. Gynecol Endocrinol 2022; 38:885-888. [PMID: 36002954 DOI: 10.1080/09513590.2022.2114448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
The aim of this study was to describe a case of ovarian torsion necrosis due to delayed treatment of luteoma in a woman with IVF twin pregnancy who was misdiagnosed with acute appendicitis. We summarized the clinical manifestations and diagnosis of luteoma in a woman with IVF twin pregnancy and reviewed the relevant literature. We report the case of a 34-year-old Asian female who became pregnant through in vitro fertilization (IVF) and had acute right underbelly pain at 26 weeks and 6 days of gestation, which was misdiagnosed as acute appendicitis. Written consent was obtained from the patient. After fasting for a short duration and receiving anti-inflammatory and intravenous fluid replacement treatment after admission, the woman experienced increased right lower abdominal pain without relief and decreased fetal movement. B-ultrasound and CT examination showed that luteoma torsion was possible, and we performed emergency surgical laparotomy. During the operation, it was found that the right ovary was enlarged, the fallopian tube was twisted 720 degrees, and there was no lesion in the appendix. The right necrotic ovary was removed, and pathological results showed a hemorrhagic corpus luteum in the right ovary. The patient's abdominal pain was relieved after the operation and the pregnancy was continued. This is a typical case of ovariectomy associated with a luteoma of pregnancy. Whether in vitro fertilization and related procedures increase the risk of luteoma and whether they increase the risk of ovarian torsion necrosis in the case of luteoma formation are questions that need further study.
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Affiliation(s)
- Lihua Zhu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu, China
| | - Dachuan Zhang
- Department of Pathology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu, China
| | - Yanjun Yang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu, China
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5
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McGee RG, Sinn J, Nyunt O. Unexpected cause of neonatal virilisation. J Paediatr Child Health 2022; 58:1083-1084. [PMID: 34651366 DOI: 10.1111/jpc.15753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/15/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Richard G McGee
- Paediatric Endocrinology, Gosford Hospital, Sydney, New South Wales, Australia
| | - John Sinn
- Sydney Medical School (Northern), The University of Sydney, Sydney, New South Wales, Australia.,Newborn Care, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ohn Nyunt
- Sydney Medical School (Northern), The University of Sydney, Sydney, New South Wales, Australia.,Department of Paediatric Diabetes and Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Paediatric Endocrinology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia
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6
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Clinical spectrum of female genital malformations in prenatal diagnosis. Arch Gynecol Obstet 2022; 306:1847-1862. [DOI: 10.1007/s00404-022-06441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/09/2022] [Indexed: 11/02/2022]
Abstract
Abstract
Introduction
Fetal genital malformations represent a rare and heterogeneous group of congenital malformations of the disorders of sexual development (DSD) spectrum.
Methods
A thorough literature review on the main topics in the prenatal approach towards DSD was conducted.
Results
First, a thorough overview on prenatal characteristics of the most common fetal genital malformations of ovaries, uterus and external genitalia, and second, a standardized approach for differential diagnosis in the presence of direct and indirect prenatal signs of DSDs.
Conclusions
This review is mainly directed towards the aspects of female genital malformations with aspects of male DSD explained as well to aid in the prenatal differential diagnosis.
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7
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Neven ACH, Mousa A, Boyle JA, Teede HJ. Endocrine and metabolic interactions in healthy pregnancies and hyperinsulinemic pregnancies affected by polycystic ovary syndrome, diabetes and obesity. Front Endocrinol (Lausanne) 2022; 13:993619. [PMID: 36733795 PMCID: PMC9886898 DOI: 10.3389/fendo.2022.993619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/06/2022] [Indexed: 01/18/2023] Open
Abstract
During pregnancy, the fetoplacental unit is key in the pronounced physiological endocrine changes which support pregnancy, fetal development and survival, birth and lactation. In healthy women, pregnancy is characterized by changes in insulin sensitivity and increased maternal androgen levels. These are accompanied by a suite of mechanisms that support fetal growth, maintain glucose homeostasis and protect both mother and fetus from adverse effects of pregnancy induced insulin and androgen excess. In pregnancies affected by endocrine, metabolic disorders such as polycystic ovary syndrome (PCOS), diabetes and obesity, there is an imbalance of beneficial and adverse impacts of pregnancy induced endocrine changes. These inter-related conditions are characterized by an interplay of hyperinsulinemia and hyperandrogenism which influence fetoplacental function and are associated with adverse pregnancy outcomes including hypertensive disorders of pregnancy, macrosomia, preterm delivery and caesarean section. However, the exact underlying mechanisms and relationships of the endocrine and metabolic milieu in these disorders and the impact they have on the prenatal endocrine environment and developing fetus remain poorly understood. Here we aim to review the complex endocrine and metabolic interactions in healthy women during normal pregnancies and those in pregnancies complicated by hyperinsulinemic disorders (PCOS, diabetes and obesity). We also explore the relationships between these endocrine and metabolic differences and the fetoplacental unit, pregnancy outcomes and the developing fetus.
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Affiliation(s)
- Adriana C. H. Neven
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Jacqueline A. Boyle
- Monash Department of Obstetrics and Gynaecology, Monash Health, Clayton, VIC, Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
- *Correspondence: Jacqueline A. Boyle,
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
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8
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Mvunta DH, Amiji F, Suleiman M, Baraka F, Abdallah I, Kazabula M, Wangwe PJT, August F. Hirsutism Caused by Pregnancy Luteoma in a Low-Resource Setting: A Case Report and Literature Review. Case Rep Obstet Gynecol 2021; 2021:6695117. [PMID: 33833884 PMCID: PMC8016591 DOI: 10.1155/2021/6695117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 11/18/2022] Open
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.
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Affiliation(s)
- David Hamisi Mvunta
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Mawenzi Regional Referral Hospital, P.O. Box 3054, Moshi, Tanzania
| | - Fatemazahra Amiji
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
| | - Mubina Suleiman
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Mnazi Mmoja Hospital, P.O. Box 236, Zanzibar, Tanzania
| | - Francisco Baraka
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Maweni Regional Referral Hospital, P.O. Box 16, Kigoma, Tanzania
| | - Ikrah Abdallah
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Kondoa District Hospital, P.O. Box 40, Dodoma, Tanzania
| | - Mabula Kazabula
- Department of Obstetrics and Gynecology, Lugalo Military Hospital, P.O. Box 60126, Mwenge, Dar es Salaam, Tanzania
| | - Peter J. T. Wangwe
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
| | - Furaha August
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
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9
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Castets S, Nguyen KA, Plaisant F, Prudon MB, Plotton I, Kassai B, Roche S, Ecochard R, Claris O, Nicolino M, Villanueva C, Gay CL. Reference values for the external genitalia of full-term and pre-term female neonates. Arch Dis Child Fetal Neonatal Ed 2021; 106:39-44. [PMID: 32561564 DOI: 10.1136/archdischild-2019-318090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Identifying virilisation of the genitalia in female newborns early during the neonatal period is important to diagnose pathologies. However, there is no clear threshold for clitoromegaly or for the anogenital ratio. The objective of this study was to define reference values for the external genitalia of full-term and pre-term female neonates. DESIGN This was a prospective study of all females born in the study centre between May 2014 and July 2016. Clitoral length and anogenital ratio were measured in 619 newborns with a gestational age of 24+2 to 41+3 weeks during their first 3 days of life. Associations between the values at day 3 and gestational age, birth weight and other newborn characteristics were examined by linear regression. RESULTS The mean clitoral length at day 3 of life was 3.69±1.53 mm (n=551; 95th percentile, 6.5 mm; maximum, 8 mm), and the mean anogenital ratio was 0.42±0.09 (95th percentile, 0.58). There was no significant variation with gestational age or birth weight, and no significant difference between the results at day 0 and day 3. CONCLUSION These results suggest that clitoromegaly can be defined as a clitoral length >6.5 mm. Values ≥8 mm should prompt further investigations. An anogenital ratio >0.6 should be considered a sign of virilisation. Since clitoral size does not vary with gestational age or birth weight, clitoromegaly should not be attributed to prematurity.
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Affiliation(s)
- Sarah Castets
- Service d'endocrinologie pédiatrique, Hospices Civils de Lyon, Lyon, France .,Pédiatrie multidisciplinaire, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Kim-An Nguyen
- Service de néonatologie et de réanimation néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Franck Plaisant
- Service de néonatologie et de réanimation néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Malika Baya Prudon
- Service de néonatologie et de réanimation néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Ingrid Plotton
- Laboratoire de biochimie et de biologie moléculaire, Hospices Civils de Lyon Centre de pathologie et biologie Est, Bron, France
| | - Behrouz Kassai
- Service de pharmacologie clinique, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique Santé, CNRS UMR 5558, Universite de Lyon, Lyon, France
| | - Sylvain Roche
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Rene Ecochard
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Olivier Claris
- Service de néonatologie et de réanimation néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Marc Nicolino
- Service d'endocrinologie pédiatrique, Hospices Civils de Lyon, Lyon, France.,INSERM U870, Université de Lyon, Lyon, France.,Centre de référence du développement génital, du fœtus à l'adulte, Hospices Civils de Lyon, Lyon, France
| | - Carine Villanueva
- Service d'endocrinologie pédiatrique, Hospices Civils de Lyon, Lyon, France
| | - Claire-Lise Gay
- Service d'endocrinologie pédiatrique, Hospices Civils de Lyon, Lyon, France.,Centre de référence du développement génital, du fœtus à l'adulte, Hospices Civils de Lyon, Lyon, France
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10
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Devlin K, Payton A, Rubino J, Shapiro R. A Rare Case of Benign Luteomas of Pregnancy Masquerading as Malignancy. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320905864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A luteoma is a benign ovarian mass that can have malignant characteristics on sonography. Pelvic sonography is used to help distinguish benign from malignant masses. The workup of adnexal masses during pregnancy may involve the use of both transabdominal and transvaginal sonography as well as Doppler imaging, magnetic resonance imaging, and serum tumor markers to identify the risk of malignancy. This study presents a case of a benign ovarian luteoma of pregnancy detected during sonography. The mass was removed during the first trimester due to malignant sonographic features. Counseling and treatment regarding ovarian masses should consist of a multidisciplinary team made up of physicians in maternal-fetal medicine, radiology, neonatology, and sonographers.
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Affiliation(s)
- Kelly Devlin
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Amber Payton
- School of Medicine, West Virginia University, Morgantown, WV, USA
- Department of Obstetrics & Gynecology, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Jessica Rubino
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Robert Shapiro
- School of Medicine, West Virginia University, Morgantown, WV, USA
- Department of Obstetrics & Gynecology, School of Medicine, West Virginia University, Morgantown, WV, USA
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11
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Bustamante C, Hoyos-Martínez A, Pirela D, Díaz A. In utero virilization secondary to a maternal Krukenberg tumor: case report and review of literature. J Pediatr Endocrinol Metab 2017; 30:785-790. [PMID: 28682787 DOI: 10.1515/jpem-2016-0433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 05/12/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Krukenberg tumors are ovarian metastatic adenocarcinomas with a primary origin usually located in the stomach, colon, gallbladder, pancreas, or breast. Occasionally, these tumors produce virilization in the affected individual due to androgen production by luteinization of the tumoral stroma. It is believed that during pregnancy these tumors are more likely to increase androgen production due to the elevated levels of human chorionic gonadotropin (hCG). High maternal androgens can cross the placenta producing virilization of the female fetus. CASE PRESENTATION A 46,XX newborn female, whose mother was diagnosed with a metastatic ovarian tumor during her second trimester of gestation associated with worsening hirsutism and acne, was found to have ambiguous genitalia at birth. Testosterone levels in both the mother and infant were elevated. Follow-up laboratory tests showed progressive normalization of circulating androgens after delivery. CONCLUSIONS Krukenberg tumors are rare and may produce virilization of the mother and the female fetus when present during pregnancy.
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12
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Hakim C, Padmanabhan V, Vyas AK. Gestational Hyperandrogenism in Developmental Programming. Endocrinology 2017; 158:199-212. [PMID: 27967205 PMCID: PMC5413081 DOI: 10.1210/en.2016-1801] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/07/2016] [Indexed: 12/16/2022]
Abstract
Androgen excess (hyperandrogenism) is a common endocrine disorder affecting women of reproductive age. The potential causes of androgen excess in women include polycystic ovary syndrome, congenital adrenal hyperplasia (CAH), adrenal tumors, and racial disparity among many others. During pregnancy, luteoma, placental aromatase deficiency, and fetal CAH are additional causes of gestational hyperandrogenism. The present report reviews the various phenotypes of hyperandrogenism during pregnancy and its origin, pathophysiology, and the effect of hyperandrogenism on the fetal developmental trajectory and offspring consequences.
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Affiliation(s)
- Christopher Hakim
- College of Human Medicine, Michigan State University, East Lansing, Michigan 48824
| | - Vasantha Padmanabhan
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan 48109; and
| | - Arpita K. Vyas
- College of Human Medicine, Michigan State University, East Lansing, Michigan 48824
- Department of Pediatrics, Texas Tech University Health Sciences Center, Permian Basin Campus, Odessa, Texas 79763
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13
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Luteoma of Pregnancy Presenting with Severe Maternal Virilisation: A Case Report. Case Rep Obstet Gynecol 2016; 2016:3523760. [PMID: 27660728 PMCID: PMC5021856 DOI: 10.1155/2016/3523760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/09/2016] [Indexed: 11/27/2022] Open
Abstract
Luteoma of pregnancy is a rare, benign condition characterized by a tumor-like mass of the ovary that emerges during pregnancy and regresses spontaneously after delivery. It is usually asymptomatic and the diagnosis is generally incidental. Luteoma arises from the proliferation of luteinised cell under the influence of β-hCG and can be hormonally active, with production of androgens resulting in maternal and fetal hirsutism and virilisation. We report a case of a 25-year-old primigravida who presented at 28 weeks of gestation with virilisation symptoms. Serum androgen levels were seven-hundred-fold higher than normal. A diagnosis of pregnancy luteoma was made at the time of caesarean section. The ovarian mass, serum androgen levels, and the condition of the patient improved after delivery.
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14
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Abstract
Pregnancy luteomas are rare, nonneoplastic lesions of the ovary thought to be caused by the hormonal effects of pregnancy. Most of these patients are asymptomatic with the ovarian enlargement being incidentally discovered during imaging or surgery. Some patients develop hirsutism or virilization during late pregnancy. Luteomas spontaneously regress postpartum. It may be a diagnostic and management challenge as it can mimic the presentation of malignant ovarian tumors. We present a 33-year-old female with an enlarged ovary discovered incidentally at the time of cesarean section.
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Affiliation(s)
- Vaishali Verma
- Department of Pathology, Government Medical College, Amritsar, Punjab, India
| | - Surinder Paul
- Department of Pathology, Government Medical College, Amritsar, Punjab, India
| | - K S Chahal
- Department of Pathology, Government Medical College, Amritsar, Punjab, India
| | - Jaspreet Singh
- Department of Pathology, Government Medical College, Amritsar, Punjab, India
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15
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Nanda A, Gokhale UA, Pillai GR. Bilateral pregnancy luteoma: a case report. Oman Med J 2014; 29:371-2. [PMID: 25337317 DOI: 10.5001/omj.2014.98] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 08/15/2014] [Indexed: 11/03/2022] Open
Abstract
Pregnancy luteoma is a non-neoplastic lesion of the ovary occurring during pregnancy and is usually discovered incidentally at the time of a cesarean section or during postpartum tubal ligation. An accurate diagnosis is important for the mother and the fetus as it can be confused with ovarian malignancy leading to unnecessary surgery. We report a case of a pregnant female who was discovered to have bilateral enlarged ovaries at the time of emergency cesarean section.
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Affiliation(s)
- Annu Nanda
- Sultan Qaboos Hospital, Salalah, Sultanate of Oman
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16
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Affiliation(s)
- Esther Oliva
- James Homer Wright Pathology Laboratories, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,
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17
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Ekenze SO, Adiri CO, Igwilo IO, Onumaegbu OO. Virilized external genitalia in young girls: clinical characteristics and management challenges in a low-resource setting. J Pediatr Adolesc Gynecol 2014; 27:6-9. [PMID: 24332612 DOI: 10.1016/j.jpag.2013.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 07/04/2013] [Accepted: 07/09/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Virilization of the external genitalia in young girls (VEG) manifests mostly as ambiguity of the genitalia and elicits concerns and uncertainties especially in settings with poor awareness. This study evaluates the profile and challenges of VEG in southeast Nigeria. METHODS We analyzed 23 children with VEG managed in 2 referral centers in southeast Nigeria from June 2005 to January 2013. RESULTS They presented at median age of 13.3 months (interquartile range [IQR] 3 months-3 years). The cases included 3 (13%) of Prader type 1, 6 (26%) of type 2, 11 (48%) of type 3, and 3 (13%) of type 4. Five of the Prader type 3 and all 3 cases of Prader type 4 were reared as male prior to presentation. Following evaluation, all the cases were assigned female gender at a mean age of 2.7 years (range 2 months-10.5 years). Appropriate feminizing genitoplasty was undertaken in all the cases and after a follow-up period of 3 months to 5 years (mean 2 years), 2 patients developed vaginal stenosis, and 3 cases had surgical wound infection. Poor awareness, delayed presentation, inadequate facilities, and lack of trained manpower were the challenges in the management of the cases. CONCLUSION VEG in our setting is associated with delayed management. Focused health education and public awareness programs, and improved healthcare funding may improve outcome and minimize the need for gender reassignment.
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Affiliation(s)
- S O Ekenze
- Sub-Department of Paediatric Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
| | - C O Adiri
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - I O Igwilo
- Sub-Department of Paediatric Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - O O Onumaegbu
- Plastic Surgery Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
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18
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Haroon S, Idrees R, Zia A, Memon A, Fatima S, Kayani N. Ovarian Sex Cord Stromal Tumours in Children and Young Girls - A More Than Two Decade Clinicopathological Experience in a Developing Country, Pakistan. Asian Pac J Cancer Prev 2014; 15:1351-5. [DOI: 10.7314/apjcp.2014.15.3.1351] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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19
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Cabrera SM, Rogol AD. Testosterone exposure in childhood: discerning pathology from physiology. Expert Opin Drug Saf 2013; 12:375-88. [DOI: 10.1517/14740338.2013.782000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Abstract
A number of factors have contributed to a sharp increase in the number of publications related to disorders of sex development (DSD) in the past 5 years, namely: the establishment of a consensus in 2006 about nomenclature, investigations and the need to treat these patients in a multidisciplinary setting; increase of the knowledge base about genetic mechanisms of normal and abnormal sex development; critical appraisal about the timing and nature of genital surgery in patients with DSD. Herein, the authors present a comprehensive review with up-to-date data about the approach to the newborn with ambiguous genitalia as well as the diagnosis and management of the most common DSD.
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Affiliation(s)
- Rodrigo L P Romao
- Division of Urology, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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21
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Kalelioglu IH, Karamustafaoglu B, Has R. A case of hyperreactio luteinalis associated with fetal cystic hygroma. J OBSTET GYNAECOL 2012; 32:303-4. [PMID: 22369412 DOI: 10.3109/01443615.2011.645095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- I H Kalelioglu
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul, Turkey
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22
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Lalwani N, Patel S, Ha KY, Shanbhogue AK, Nagar AM, Chintapalli KN, Prasad SR. Miscellaneous tumour-like lesions of the ovary: cross-sectional imaging review. Br J Radiol 2012; 85:477-86. [PMID: 22253351 DOI: 10.1259/bjr/92819127] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Miscellaneous tumour-like ovarian lesions are histobiologically diverse, and are often mistaken for the more common ovarian cancers, leading to aggressive management. Knowledge of characteristic clinical, laboratory and imaging findings of these select non-neoplastic ovarian entities allows correct diagnoses and permits optimal management.
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Affiliation(s)
- N Lalwani
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
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23
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Abstract
Hyperandrogenic states in pregnancy are almost always the result of a condition that arises during pregnancy. The onset of virilization symptoms is often very fast. The mother is protected against hyperandrogenism by a high level of SHBG, by placental aromatase and a high level of progesterone. The fetus is protected from the mother’s hyperandrogenism partly by the placental aromatase, that transforms the androgens into estrogens, and partly by SHGB. Nevertheless there is a significant risk of virilization of the female fetus if the mother’s hyperandrogenic state is serious. The most frequent cause of hyperandrogenic states during pregnancy are pregnancy luteoma and hyperreactio luteinalis. Hormonal production is evident in a third of all luteomas, which corresponds to virilization in 25-35 % of mothers with luteoma. The female fetus is afflicted with virilization with two thirds of virilized mothers. Hyperreactio luteinalis is created in connection with a high level of hCG, e.g. during multi-fetus pregnancies. This condition most frequently arises in the third trimester, virilization of the mother occurs in a third of cases. Virilization of the fetus has not yet been described. The most serious cause of hyperandrogenism is represented by ovarian tumors, which are fortunately rare.
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Affiliation(s)
- N. KAŇOVÁ
- Institute of Endocrinology, Prague, Czech Republic
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24
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Mavromatidis G, Sotiriadis A, Dinas K, Mamopoulos A, Rousso D. Large luteinized follicular cyst of pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:517-520. [PMID: 20499403 DOI: 10.1002/uog.7691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A large (165 × 235 × 250 mm) solitary, unilocular cyst with a thin, smooth wall and homogeneous anechoic content was detected during a routine ultrasound scan at 24 weeks of gestation in an asymptomatic 39-year-old woman with a singleton pregnancy. The cyst was aseptate, lacked mural blood flow and was not associated with ascites. It was located in the central abdominal area above and anterior to the uterus. Gradually increasing abdominal discomfort developed, and a laparotomy was performed at 27 weeks; the cyst was removed after aspiration of 6.3 L of serous fluid and the ipsilateral ovary was preserved. Pathological examination indicated a large luteinized follicular cyst of pregnancy. A healthy male infant was delivered vaginally at term. A rapidly enlarging ovarian mass in pregnancy poses significant diagnostic problems. Large luteinized cysts of pregnancy are uncommon and thought to involve stimulation by human chorionic gonadotropin (hCG), or increased tissue sensitivity to hCG. A literature search identified four previous cases that had been detected prenatally. With one exception, the cysts appeared to enlarge during pregnancy, eventually becoming symptomatic, and two previous cases also required removal of the cyst before birth. Adverse pregnancy outcome was only reported in one of the previous cases. In summary, large luteinized cysts of pregnancy are an uncommon type of cystic mass particular to pregnancy, characterized by the combination of a benign appearance and a tendency to enlarge rapidly, eventually becoming symptomatic and most often necessitating surgery.
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Affiliation(s)
- G Mavromatidis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
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26
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Chitayat D, Glanc P. Diagnostic approach in prenatally detected genital abnormalities. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:637-646. [PMID: 20521311 DOI: 10.1002/uog.7679] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Abstract
The 46,XX disorders of sex development (DSDs) cause virilisation or masculinisation of the female foetus. The final common pathway of all 46,XX DSDs is excess dihydrotestosterone (DHT) or potent foreign androgen in the genital tissue during the critical period of sexual differentiation. Whereas the foetal testis is source of androgen in the male, it is the foetal adrenal that produces the DHT precursors in the female. By understanding the principles of human steroid biosynthesis, the pathogenesis of each disorder may be logically deduced, and treatment strategies are rationally constructed. In practice, however, therapies for many of these diseases are fraught with complications and caveats, and current approaches leave much room for improvement. This review discusses these diseases, their pathogenesis and approaches to therapy. We emphasise areas where improved treatments are sorely needed.
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Affiliation(s)
- Richard J Auchus
- Division of Endocrinology and Metabolism, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8857, United States.
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28
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Medeiros F, Bell DA. Pseudoneoplastic Lesions of the Female Genital Tract. Arch Pathol Lab Med 2010; 134:393-403. [DOI: 10.5858/134.3.393] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Numerous benign, proliferative, or reactive processes, often related to hormone stimulation or inflammation, occur throughout the female genital tract and may mimic benign or malignant tumors. Several of the more common pseudoneoplastic lesions are discussed in this article, including microglandular hyperplasia of the cervix mimicking well-differentiated endometrial adenocarcinoma, reactive epithelial changes in the fallopian tubes mimicking adenocarcinoma or carcinoma in situ, and pregnancy changes in the ovary including pregnancy luteoma and large solitary luteinized follicular cyst of pregnancy and puerperium that may mimic ovarian neoplasms.
Objectives.—To discuss and illustrate several common lesions of the female genital tract that mimic neoplasms.
Data Sources.—Material derived from consultation cases and review of the literature.
Conclusions.—Many benign hyperplastic or reactive processes that occur in the female genital tract may be mistaken for neoplasms both clinically and pathologically. Awareness of the features of such lesions will aid in their correct diagnosis and prevent overtreatment of benign processes.
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