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Hyperreactio Luteinalis : Treatment

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Differential Diagnosis of Hyperreactio Luteinalis (HL): The appearance of the ovaries at laparoscopy may lead to the mistaken diagnosis of cystic ovarian tumors. Clinical information is crucial in establishing the correct diagnosis.

Treatment: Operative intervention is to be avoided if possible. Most cases of HL undergo regression during puerperium. Rare cases regress spontaneously during pregnancy. In some cases, the cysts take 6 months or longer to resolve. In the setting of gestational trophoblastic disease, the cysts regress within 2 to 12 weeks after evacuation of the uterus. Surgical intervention is sometimes needed to control hemorrhage and remove necrotic tissue when complications arise (intracystic hemorrhage, rupture, torsion, and hemoperitoneum). Resection may also become necessary to control androgen production in virilized patients.

Clinical History: This pregnant patient was found to have bilateral ovarian enlargement at the time of cesarean section. The right and left ovaries measured 38 cm and 26 cm in maximum dimension. The sections are from the right ovary which was removed. They showed multiple cystic follicles lined by luteinized granulosa and theca interna cells confirming the diagnosis of hyperreactio luteinalis. The patient had singleton pregnancy and no underlying causes.

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