Review Question - QID 105171

This multiparous, pregnant African American female with virilization and bilateral solid ovarian masses most likely has luteomas of pregnancy. Appropriate treatment for this benign condition is reassurance and repeat ultrasound following delivery.

Luteomas are rare solid, benign ovarian masses that often present bilaterally and occur during pregnancy with spontaneous regression post-partum. They can lead to increases in progesterone and testosterone levels, resulting symptoms of virilization in about one third of cases. In those who are symptomatic, their infant, if female, may also show signs of virilization.

Givens et al. give an overview of adnexal masses. These masses can be categorized by origin (gynecological vs. nongynecological) and/or seriousness (benign vs. malignant). Symptoms can be vague so diagnosis requires a high index of suspicion. Transvaginal ultrasound is the best tool for initial evaluation and can help differentiate between benign and malignant masses.

Masarie et al. review presentation and management of pregnancy luteomas. Although often asymptomatic, these masses can mimic malignant ovarian tumors, which presents a challenge. As a rule of thumb, patients who present earlier in pregnancy are more likely to have a more severe presentation and require an intervention, such as surgery, rather than conservative management.

Figure A shows an ultrasound of the right adnexa. A 10 cm solid mass, which is a luteoma of pregnancy, is present.
Illustration A shows a gross cross section of a luteoma of pregnancy.

Incorrect Answers:
Answers 1-4: This benign condition does not require treatment. For adnexal masses in general, if malignancy is suspected, appropriate treatment is bilateral salpingo-oophorectomy, staging and referral to an oncologist. If malignancy is of intermediate risk, cystectomy may be performed for diagnostic purposes.