Abstract
Hyperreactio luteinalis is a condition associated with bilateral and, in rare cases,
unilateral ovarian enlargement due to theca lutein cysts. Hyperreactio luteinalis
is a benign condition, usually found incidentally at cesarean section, which can appear
anaplastic and lead to unnecessary ovarian resection. A 21-year-old Hispanic woman,
G2P1, presented at 19 weeks with a singleton pregnancy, bilaterally enlarged ovaries,
and a normal βhCG. Over the next four months, her ovaries increased 75% in size with
the right ovary becoming entrapped in the pelvis. The patient underwent a primary
low transverse cesarean section. The ovaries had an anaplastic appearance and on frozen
section revealed multiple benign theca lutein cysts. There are 51 reported cases of
hyperreactio luteinalis associated with a normal pregnancy in the literature. It is
estimated that approximately 60% of the cases of hyperreactio luteinalis unassociated
with trophoblastic disease occur with normal singleton pregnancy. There are multiple
benign ovarian lesions including hyperreactio luteinalis that can mimic ovarian neoplasms.
Accordingly, it is important to exclude these from the differential diagnosis via
a wedge biopsy and frozen section to avoid unnecessary surgical excision.
Keywords
Hyperreactio luteinalis - ovarian neoplasm - ovarian enlargement - theca lutein cysts
