Hyperreactio luteinalis mit Zufallsbefund eines serösen Borderline-Tumor des Ovars FIGO IIIB im 3. Trimenon – Diagnostik, Therapie, Literaturrecherche

Zusammenfassung

Raumforderungen der Adnexe betreffen 2–10% aller Schwangerschaften. Die höchste Inzidenz mit 1–6% lässt sich im ersten Trimenon beobachten, bei hoher Spontanremission im Schwangerschaftsverlauf. Bei 2% dieser Raumforderungen handelt es sich um maligne Neoplasien oder Borderline-Tumore. Eine seltene benigne Raumforderung der Adnexe in der Schwangerschaft ist die Hyperreactio luteinalis. Sie ist gekennzeichnet durch bilaterale, multizystisch veränderte Ovarien mit einem gehäuften Auftreten im 3. Trimenon. Klinisch zeigen sich u. a. eine maternale Hyperandrogenämie mit Virilisierung, Hyperemesis, unspezifische Bauchschmerzen oder laborchemisch eine Hyperthyreose sowie ein erhöhtes ß-HCG. Die Hyperreactio luteinalis bedarf keiner Therapie bei kompletter Remission postpartal, wird jedoch oft in graviditate operativ behandelt. In unserem Fall berichten wir von einer Erstgravida in der 31. Schwangerschaftswoche (SSW) mit einer symptomatischen 25 cm großen multizystischen, teils soliden Raumforderung. Bei Malignitätsverdacht erfolgte nach abgeschlossener Lungenreifung eine Explorativlaparotomie mit rechtsseitiger Adnexektomie. Histologisch ergab sich eine Hyperreactio luteinalis mit Zufallsbefund eines serösen Borderline-Tumor des Ovars FIGO IIIB. Bei pathologischem CTG erfolgte in der 33. Schwangerschaftswoche eine eilige sekundäre Sectio per Re-Längslaparotomie. Post partum entschloss sich die Patientin nach reproduktionsmedizinischer und onkologischer Beratung zur Komplettierungsoperation, wobei sich histologisch kein weiterer Nachweis des vordiagnostizierten serösen Borderlinetumors fand.

Abstract

Adnexal masses affect 2–10% of all pregnancies. The highest incidence of 1–6% can be seen in the first trimester, with a high rate of spontaneous remission. Two percent of these masses are malignant neoplasms or borderline tumors. A rare benign mass of the adnexa in pregnancy is hyperreactio luteinalis characterised by bilateral, multicystic ovaries with a frequent occurrence in the 3^rd trimester. Clinical signs include maternal hyperandrogenaemia with virilisation, hyperemesis, nonspecific abdominal pain or laboratory findings of hyperthyroidism and elevated ß-HCG. Hyperreactio luteinalis does not require therapy due to complete spontaneous remission postpartum, but is often treated surgically in graviditate. In our case we report a first-time gravida in the 31^st week of pregnancy with a symptomatic 25-cm multicystic, partly solid mass. After antenatal corticosteroid therapy, an exploratory laparotomy with right adnexectomy was performed on suspicion of malignancy. Histology revealed a hyperreactio luteinalis with an incidental finding of a serous borderline tumor of the ovary (FIGO IIIB). At 33 weeks of gestation, a pathological CTG was observed, and an urgent secondary caesarean section by re-longitudinal laparotomy was performed. Postpartum completion surgery revealed no further neoplastic cells.

Schlüsselwörter

Multizystische Ovarien - Hyperreactio luteinalis - seröser Borderline Tumor - Schwangerschaft

Key words

multicystic ovaries - hyperreactio luteinalis - serous borderline tumor - pregnancy

Publication History

Received: 05 February 2023

Accepted after revision: 22 March 2023

Article published online:
02 May 2023

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