CORRESPONDENCE
5. Fayez, J. A., Bunch, T. R., and Miller, G. L.: Obstet. Gynecol. 44:511, 1974. 6. Hensleigh, P. A., Carter, R. P., and Grotjan, H. E., Jr.: J. Clin. Endocrinol. Metab. 40: 816, 1975.
Luteoma of pregnancy To the Editors: The case report of Drs. Tucker, Buell, and Fisher (AM.J. OBSTET. GYNECOL. 121:282, 1974) would seem to imply that all benign ovarian tumors of pregnancy
associated with virilization are "luteontas." In fact, the "luteoma of pregnancy," as described by Sternberg and Barclay, 1 is a solid ovarian hyperplastic lesion lvhich has been associated with maternal virilization in about 10 oer cent of reported cases. The cvstic hvoerolascic le~ion which T~cker, Bell, and Fisher rep~rt ·does not fit the definition for a "luteoma of pregnancy" since no solid tumor was found. The gross and microscopic descriptions of this patient's hyperplastic ovaries suggest that she actually had multiple theca-lutein cysts which correlates with the pathologic picture of hyperreactio luteinalis which was recently reviewed by Caspi and associates. 2 The authors also referred to a similar case of Jewelewicz and colleagues3 which was reported as a "luteoma." Review of this case, including the microscopic slides which were shared with me by the authors, indicates that their case also represents hyperreactio luteinalis rather than luteoma of pregnancy. Thus, while I would fully agree that early testing for abnormal androgen production in the hyperplastic ovarian syndromes of pregnancy is important, the proper pathologic classification of the tumors must also be established. Although luteoma of pregnancy has traditionally been associated with maternal virilization, it is apparent from these reports and others in the recent literature4 - 6 that other benign neoplasms, particularly hyperreactio luteinalis, may produce potent androgens and virilize the mother.
Reply to Dr. Hensteigh To the Editors: It was not our intention to imply that luteoma of pregnancy is the only benign tumor causing virilization- duri~g pregnan~y. and our case report did not state this. There are other rare causes, as Dr. Hensleigh points out. Dr. Hensleigh objects to the classification of our case as luteoma of pregnancy because no solid tumor was found in the wedge biopsies. We would remind him that the nature of a tumor is not determined by whether it is solid or cystic but by the histologic features of the cells which compose it. The histologic distinctiveness of "luteoma cells" as compared to "thecalutein cyst cells" has been demonstrated nicely by Norris and Taylor. 1 We believe that the histology in our case, as well as the clinical course, is that of luteoma of pregnancy. Total ovarian resection is not the recommended treatment for suspected luteoma of pregnancy; therefore, one must rely on the histology present in the specimen obtained, and the clinical course, in making the diagnosis. However, one must be cautious not to make too rigid a classification of the follicular lutenization changes seen in pregnancy. There appears to be a spectrum of change which ranges from theca-lutein cyst formation, to focal theca-lutein cell hyperplasia, to obliteration of the follicular cavity with nodule formation.2 These changes have been seen in a singie ovary. 1• 3 Stephen B. Tucker, [t,i.D. James Buell, M.D. H. Ru~sell FishRr, M.D. 1432 20th St., N.W. Rochester, Minnesota 55901
Paul A. Hensleigh, M. JJ., Ph.D. Department of Gynecology and Obstetrics
University of Kansas l"fedical Cen-ter Kansas City, Kansas 66103 REFERENCES
J. OBsTET. GYNECOL 95: ] 65, ] 966. 2. Caspi, E., Schreyer, P., and Bukovsky,J.: Obstet. Gynecol. 42: 388, 1973. 3. Jewelewicz, R., Perkins, R. P., Dyrenfurth, I., and Vande Wiele, R. L.: AM. J. 0BsTET. GYNECOL. 109: 24, 1971. 4. Judd, H. L., Benirschke, K., DeVane, G., Reuter, S. R., and Yen, S. S.C.: N. Engi.J. Med. 288: 118, 1973. I. Sternberg, W. H., and Barclay, D. L.: AM.
REFERENCES 1. Norris, H. J., and Taylor, H. B.: Nodular theca-lutein hyperplasia of pregnancy (so called "pregnancy luteoma"): A clinical and pathologic study of 15 cases, Am. J. Clin. Pathol. 47: 557, !967.
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5. Fayez, J. A., Bunch, T. R., and Miller, G. L.: Obstet. Gynecol. 44:511, 1974. 6. Hensleigh, P. A., Carter, R. P., and Grotjan, H. E., Jr.: J. Clin. Endocrinol. Metab. 40: 816, 1975.
Luteoma of pregnancy To the Editors: The case report of Drs. Tucker, Buell, and Fisher (AM.J. OBSTET. GYNECOL. 121:282, 1974) would seem to imply that all benign ovarian tumors of pregnancy
associated with virilization are "luteontas." In fact, the "luteoma of pregnancy," as described by Sternberg and Barclay, 1 is a solid ovarian hyperplastic lesion lvhich has been associated with maternal virilization in about 10 oer cent of reported cases. The cvstic hvoerolascic le~ion which T~cker, Bell, and Fisher rep~rt ·does not fit the definition for a "luteoma of pregnancy" since no solid tumor was found. The gross and microscopic descriptions of this patient's hyperplastic ovaries suggest that she actually had multiple theca-lutein cysts which correlates with the pathologic picture of hyperreactio luteinalis which was recently reviewed by Caspi and associates. 2 The authors also referred to a similar case of Jewelewicz and colleagues3 which was reported as a "luteoma." Review of this case, including the microscopic slides which were shared with me by the authors, indicates that their case also represents hyperreactio luteinalis rather than luteoma of pregnancy. Thus, while I would fully agree that early testing for abnormal androgen production in the hyperplastic ovarian syndromes of pregnancy is important, the proper pathologic classification of the tumors must also be established. Although luteoma of pregnancy has traditionally been associated with maternal virilization, it is apparent from these reports and others in the recent literature4 - 6 that other benign neoplasms, particularly hyperreactio luteinalis, may produce potent androgens and virilize the mother.
Reply to Dr. Hensteigh To the Editors: It was not our intention to imply that luteoma of pregnancy is the only benign tumor causing virilization- duri~g pregnan~y. and our case report did not state this. There are other rare causes, as Dr. Hensleigh points out. Dr. Hensleigh objects to the classification of our case as luteoma of pregnancy because no solid tumor was found in the wedge biopsies. We would remind him that the nature of a tumor is not determined by whether it is solid or cystic but by the histologic features of the cells which compose it. The histologic distinctiveness of "luteoma cells" as compared to "thecalutein cyst cells" has been demonstrated nicely by Norris and Taylor. 1 We believe that the histology in our case, as well as the clinical course, is that of luteoma of pregnancy. Total ovarian resection is not the recommended treatment for suspected luteoma of pregnancy; therefore, one must rely on the histology present in the specimen obtained, and the clinical course, in making the diagnosis. However, one must be cautious not to make too rigid a classification of the follicular lutenization changes seen in pregnancy. There appears to be a spectrum of change which ranges from theca-lutein cyst formation, to focal theca-lutein cell hyperplasia, to obliteration of the follicular cavity with nodule formation.2 These changes have been seen in a singie ovary. 1• 3 Stephen B. Tucker, [t,i.D. James Buell, M.D. H. Ru~sell FishRr, M.D. 1432 20th St., N.W. Rochester, Minnesota 55901
Paul A. Hensleigh, M. JJ., Ph.D. Department of Gynecology and Obstetrics
University of Kansas l"fedical Cen-ter Kansas City, Kansas 66103 REFERENCES
J. OBsTET. GYNECOL 95: ] 65, ] 966. 2. Caspi, E., Schreyer, P., and Bukovsky,J.: Obstet. Gynecol. 42: 388, 1973. 3. Jewelewicz, R., Perkins, R. P., Dyrenfurth, I., and Vande Wiele, R. L.: AM. J. 0BsTET. GYNECOL. 109: 24, 1971. 4. Judd, H. L., Benirschke, K., DeVane, G., Reuter, S. R., and Yen, S. S.C.: N. Engi.J. Med. 288: 118, 1973. I. Sternberg, W. H., and Barclay, D. L.: AM.
REFERENCES 1. Norris, H. J., and Taylor, H. B.: Nodular theca-lutein hyperplasia of pregnancy (so called "pregnancy luteoma"): A clinical and pathologic study of 15 cases, Am. J. Clin. Pathol. 47: 557, !967.
104
![[Pregnancy luteoma].](/assets/img/hold.png)
