Massive Luteinized Follicular Cyst of Pregnancy

Department of Obstetrics and Gynecology, Winthrop-University Hospital, Mineola, New York 11501, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 06/2005; 105(5 Pt 2):1218-21. DOI: 10.1097/01.AOG.0000154001.55040.a0
Source: PubMed


A large luteinized follicular cyst can rupture or twist during pregnancy. However, in the absence of those complications a simple ovarian cyst can often be managed conservatively, provided that sonographic evaluation of the cyst is benign. Rapid growth of a simple follicular cyst is rare but may occasionally complicate pregnancy.
A 25-year-old primigravida had a simple-appearing adnexal mass detected by sonogram early in pregnancy. She was followed with serial sonograms. Because of the clear sonolucent appearance of the mass and the patient's preference, a conservative management was elected. The cyst grew in size as her pregnancy progressed, became symptomatic, and necessitated surgical intervention. Cystectomy and cesarean delivery at 36+ weeks relieved the symptoms and achieved delivery of a healthy infant.
Solitary luteinized follicular cysts of pregnancy have the potential to grow to a very large size and create complications related to their size alone. Conservative management of simple adnexal cysts in pregnancy, based on their sonographic appearance, can avoid risks of abdominal surgery in the second trimester of pregnancy, but in the third trimester, a large cyst can create significant complications requiring surgical intervention.

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    • "Postpartum CT scan showed a 32 × 32 × 20-cm cyst, which eventually Spontaneous vaginal delivery at 40 weeks, healthy male infant, birth Origin: right ovary required exploratory laparotomy as a result of (postnatal) rupture. weight 3087 g. Fang et al. 2005 5 A simple, solitary 9-cm cyst at 15 weeks. "
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    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.
    Ultrasound in Obstetrics and Gynecology 10/2010; 36(4):517-20. DOI:10.1002/uog.7691 · 3.85 Impact Factor
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    ABSTRACT: We report a huge ovarian solitary luteinized follicle cyst (SLFC) that contained 17 liters of fluid. Computed tomography scan revealed a 32 x 32 x 20 cm right simple cystic ovarian mass without calcification or septation. The fluid was removed, and the collapsed unilocular cyst was examined pathologically. No solid or papillary areas were identified. The cyst wall lining was composed of multiple layers of luteinized cells of variable size and shape with abundant eosinophilic cytoplasm and focally enlarged, pleomorphic, and hyperchromatic nuclei. Nests of luteinized cells were embedded within the fibrous tissue of the cyst wall. These findings are characteristic of solitary luteinized follicle cyst of pregnancy. Even though less than 15 cysts of this kind have been recorded, one should consider this uncommon, benign, non-neoplastic cystic ovarian lesion in the differential diagnosis of other cystic ovarian lesions.
    Pathology - Research and Practice 02/2006; 202(6):471-3. DOI:10.1016/j.prp.2006.02.001 · 1.40 Impact Factor
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    ABSTRACT: Non neoplasic masses that appear during pregnancy or postpartum together with obstetric complications are extremely rare, most times because of the size they can reach.The finding of an adnexal mass is usually casual as not-complicated ones provoque very few symptoms. The extended use of the ecography during pregnancy and postpartum will bring out a casual finding of this pathology.The management of adnexal masses during pregnancy or postpartum must be individualiced and depends on the symptoms, gestacional age, size and features of the mass.Massive luteinized follicular cyst in postpartum is an infrequent lesion in ovary that may appear during pregnancy and increases its size during postpartum untill it is detected.We present a case of a massive luteinized follicular cyst in a patient in her 6th week alter a vaginal delivery. We also perform an overview of the literature about most frequent non-oncologic ovarian masses.
    Progresos de Obstetricia y Ginecología 07/2009; 52(7). DOI:10.1016/S0304-5013(09)71814-X
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