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Luteoma of pregnancy is a rare, tumorlike ovarian mass that develops during pregnancy and regresses after delivery. Generally, these masses are discovered incidentally during cesarean delivery or tubal ligation. Some of these patients will develop hirsutism or virilization during late pregnancy with or without fetal masculinization due to circulating androgens. The imaging features of this entity have been only rarely reported. An incidentally discovered luteoma of pregnancy in a 23-year-old patient during routine obstetric ultrasound is described and the image features in ultrasound and magnetic resonance (MR) imaging are discussed and compared with other studies. The patient underwent surgery to extract this mass considering the imaging findings were suspicious for neoplasia and the size and location could have potentially caused dystocia. This type of mass can mimic ovarian neoplasia and a correlation with imaging and laboratory findings can avoid an unnecessary surgical procedure during pregnancy.

A mass was identified on the left caudal region of the abdomen in a 13-year-old bonnet monkey (Macaca radiata). The mass was excised and diagnosed as granulosa theca cell tumor accompanied with luteoma based on the microscopic findings. Morphologically it appeared pink, round, firm multilobulated measured approximately 5 x 3 x 2.5 cm in dimension. Histologically the luteoma composed of polyhedral cells with pale strained vacuolated cytoplasm, centrally located nuclei with distinct cytoplasmic borders. Granulosa theca cell tumor appeared as densely packed spindle shaped fusiform cells arranged in interlacing bundles and whorled pattern with neoplastic cells appearing irregular shaped solid sheets. The concomitant development of granulosa theca cell tumor with luteoma in a single ovary is very rare and is the first reported case in a bonnet macaque to our knowledge.

A pregnancy luteoma represents an unusual response of ovarian stromal cells to the altered hormonal levels of pregnancy. It is a distinctive non-neoplastic lesion characterized by solid proliferations of luteinized cells resulting in a tumor-like ovarian enlargement. Most patients are asymptomatic; the ovarian enlargement is usually discovered incidentally at cesarean section or during postpartum tubal ligation. We report a typical case that we found at cesarean section to be associated with a virilized infant who manifested clitoromegaly and labial fusion. We detected an increased level of testosterone in the maternal patient. We concluded that the ovarian luteoma induced the fetal virilization.

OBJECTIVE The frequency of gonadoblastoma is high in patients with Turner's syndrome bearing cells with Y or partial Y-chromosome. About 60% of patients with Turner's syndrome have a 45,X karyotype. In 30% of them a Y-sequence is disclosed by DNA analysis. To identify patients at risk of developing gonadoblastoma, a PCR based assay with SRY, ZFY and DYZ3 specific primers was carried out to detect different Y-sequences in the DNA of peripheral lymphocytes from patients with Turner's syndrome. DESIGN AND PATIENTS Peripheral blood karyotypes from 36 patients with Turner's syndrome were studied. Patients with proven Y-chromosomal material were excluded. Genomic DNA was extracted from peripheral blood. SRY and ZFY genes and DYZ3 repetion of Y-chromosome were amplified by PCR. Patients with clinical signs of hyperandrogenism or with positive Y-sequences by PCR underwent gonadectomy. The gonadal tissues were examined for Y-sequences using PCR, morphology and immunohistochemical study. MEASUREMENTS Turner's syndrome and signs of hyperandrogenism were evaluated both clinically and through laboratory tests. Haematoxylin and eosin staining was employed in gonadal morphology studies. The presence of testosterone was detected by immunohistochemistry using a monoclonal antibody. RESULTS Two patients who had Y-positive blood samples and three hyperandrogenic (2 hirsutes, 1 virilized) Y-negatives underwent gonadectomy. PCR was carried out on their gonadal tissue. The tissue from the two patients without hyperandrogenism was Y-positive. The gonadal tissue from the three hyperandrogenics was Y-negative. Gonadal morphology disclosed hilus cell hyperplasia in the 3 hyperandrogenic Y-negatives and in one Y-positive patient; stromal luteoma and hyperthecosis in the virilized patient, cystadenofibroma in one hirsute patient and gonadoblastoma in one Y-positive. Testosterone was detected immunohistochemically in the hilus cell hyperplasia, stromal luteoma and hyperthecosis found in the hyperandrogenic patients. CONCLUSIONS The molecular study was sensitive and useful in the evaluation of patients at risk of developing gonadoblastoma. Other nontumour, gonadotrophin-dependent and Y-independent mechanisms which deserve the same medical approach may be involved in the genesis of hyperandrogenic signs in Turner's syndrome.

Ovarian tumors were induced at very high incidence in the offspring of F344 rats receiving 3 subcutaneous injections of 10 mg/kg of N‐nitrosobis(2‐oxopropyl)amine on the 14th, 18th and 20th days of gestation. Histologically, all ovarian tumors were of the granulosa cell tumor and/or luteoma type. Many of them consisted of large, polygonal cells with abundant eosinophilic or vacuolated cytoplasm, arranged in sheets or in a pseudo‐palisaded pattern separated by thin fibrovascular stroma, and they exhibited typical luteoma morphological character. The high yields, and the similarities in morphology as well as putative hormonal influence suggest that this experimental system may serve as a good animal model for granulosa cell tumor and/or luteoma development in women.

Purpose: To investigate the feasibility and possible advantages of routine screening for ovarian pathology in asymptomatic pregnant women at 11–14 weeks' gestation. Methods: Pregnant women attending for a routine early anomaly scan at 11–14 weeks' gestation were invited to participate in this prospective study. In all cases, an attempt was made to visualize the ovaries on transabdominal ultrasound scan. The presence of all visible cysts was recorded. Small simple cysts 5 cm in diameter or a complex ovarian cyst had a detailed gynecological scan including color Doppler blood flow studies and serum tumor markers. Surgical intervention was offered only to women with clinical symptoms suggestive of cyst complications or those with ultrasound findings suggestive of malignancy. All other women were management expectantly until six weeks after delivery, when they were either discharged from follow up or were offered a definitive surgical intervention. Results: A total of 2925 women were included into the study. Both ovaries were seen in 1755 (60%) of women, only one ovary was seen in 614 (21%) and neither ovary was seen in 556 (19%). The presence of an ovarian cyst was recorded in 728 (25%) women. A total of 400 (55%) of these were small simple cysts which did not warrant further follow up, whilst 328 (45%) had further scans. Two hundred and seventy-eight of these cysts resolved spontaneously during pregnancy, two required surgical intervention in pregnancy, four were removed at cesarean section and 40 were still present on the postpartum scan. At postpartum scan, 11 women opted for further expectant management. The ultrasound diagnosis in these cases was dermoid cyst (8), endometrioma (2) and peritoneal pseudocyst (1). Histological diagnoses in 33 women who had surgery were: dermoid cyst (12) and endometrioma (8) benign ovarian cystadenoma (5), luteoma of pregnancy (1), corpus luteum cyst (1), hydrosalpinx (3) and fimbrial cyst (3). Six women were lost to follow up. Conclusions: Asymptomatic ovarian cysts detected at routine ultrasound screening in the first trimester are unlikely to be malignant or cause clinical symptoms later in pregnancy. The policy of routine examination of the ovaries in pregnancy should therefore be discouraged.

A case of hyperreactio luteinalis in a patient with normal singleton pregnancy is reported. The course of pregnancy had been normal until the 24th week of gestation, when the mother developed lower abdominal pain and signs of virilization. She delivered of a normal female infant at 39 weeks' gestation. The baby did not show any signs of masculinization. Serum testosterone, delta 4-androstene-dione, and 5 alpha-dihydrotestosterone of the mother were markedly elevated. They remained high after the delivery but returned to the normal ranges soon after the partial resection of the enlarged ovaries. Reported causes of hyperreactio luteinalis are reviewed. Their maternal serum androgen levels were compared with cases of luteoma of pregnancy.

The partly luteinized theca cell tumor is a variant of the theca cell tumor in which extensive foci of luteinization occur. This neoplasm belongs to a set of tumors, which includes the theca cell tumor, that is believed to be derived from mature ovarian stroma. This tumor can be classified as a tumor of specialized gonadal stroma of "ovarian cell type" intermediate between the theca cell tumor and the stromal luteoma. Two patients were virilized, and one had evidence of endometrial hyperplasia, whereas in the fourth no endocrine function was evident. None of the patients were pregnant at the time of discovery of the tumor. On gross examination these tumors consisted of a mixture of firm gray-white and yellow tissue. The presence of multiple yellow nodules in two tumors distinguished it from the usual theca cell tumor. A third tumor was distinctly lobulated. The tumor in only one of the cases arose in a background of ovarian stromal hyperplasia. Although the number of cases reported up to now is small and variability exists, the tumors tend to occur in patients in the early reproductive age group, often produce significant quantities of steroid hormones, and the clinical course has been benign.

Summary A case of malignant luteoma was found in a 3-year-old Landrace sow. A large neoplastic mass was present in the left ovary and small neoplastic nodules were seen in the right ovary. There were metastatic lesions in the diaphragmatic peritoneum and heart. The neoplastic cells were extremely pleomorphic and among them relatively large cells predominated. The neoplastic cells had lipid droplets, membranous structures, intermediate filaments and lipofuscin granules in their cytoplasm. Zusammenfassung Malignes Luteom bei einem Mutterschwein Bei einem 3 Jahre alten Mutterschwein wurde ein Luteom gefunden. Im linken Ovar war eine grose neoplastische Gewebsmasse vorhanden, und im rechten Ovar wurden kleine neoplastische Knoten gefunden. Metastatische Lasionen wurden im Peritoneum des Zwerchfells und im Herzen beobachtet. Die neoplastischen Zellen waren extrem pleomorph. Dabei dominierten relativ grose Zellen. Die neoplastischen Zellen wiesen im Zytoplasma Lipidtropfchen, membranose Strukturen, Filamente und Lipofuscin-Granula auf.

Rare benign neoplasms occur which are composed solely of Leydig cells derived from ovarian stroma rather than from preexisting hilus cells of the mesovarium. Two such tumors are described and two are noted in the literature although others, difficult to identify, undoubtedly exist. They are closely related to the stromal-Leydig cell tumor but are not multifocaland lack the thecoma-like stromal component. Both types of neoplasm occur in menopausal or post-menopausal women and are likely to be associated with masculinization. They are related to each other as the stromal luteoma is related to the partly luteinized theca cell tumor. The presence of crystalloids of Reinke in some of the lipid cells identifies the lipid cell component of the tumor as Leydig cells. Similar tumors lacking crystalloids, in fact, may be Leydig cell tumors but in the absence of definitive diagnostic criteria are best classified as lutein cell tumors.