James Homer Wright Pathology Laboratories, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (J.C.W., P.L., R.H.Y.).
Int J Gynecol Pathol. 2021 Sep 1;40(5):427-434. doi: 10.1097/PGP.0000000000000746.
Hyperreactio luteinalis is a rare entity arising in pregnancy and in the setting of gestational trophoblastic diseases (ie choriocarcinoma, molar pregnancy) that presents with, typically, bilateral ovarian enlargement due to numerous follicle cysts. While the phenomenon is benign and spontaneously regresses following delivery or treatment, a specimen may be seen in pathology when oophorectomy or cystectomy is performed to exclude malignancy or to manage acute complications such as torsion. Such resections may exhibit overlapping microscopic features with cystic granulosa cell tumors. We thus reviewed 10 cases of hyperreactio luteinalis in the setting of pregnancy, the largest pathologic cohort to date, to highlight notable features of this disorder. Patients ranged from 22 to 30 yr old. Most patients (n=6) presented at time of cesarean section with incidentally discovered ovarian masses. Three patients presented in the postpartum period, and 1 underwent surgery at 28 wk gestation due to the finding of a unilateral ovarian mass. The ovaries ranged from 8.5 to 29 cm and were multicystic and bilateral in 8 of the cases. Histologic examination demonstrated multiple, variably sized cystic follicles lined by a granulosa cell layer of varying thickness and theca cells with marked eosinophilic cytoplasm. Stromal edema was often prominent, with theca cells occasionally noted in nests, cords, and as single cells in foci of edema. Mitoses were generally seen more often in the granulosa cell layer (mean=2.6 per high power fields) compared with the theca cell layer (mean=1 per 10 high power fields). This series documents the key features of hyperreactio luteinalis that differentiate it from the other benign mass forming lesions encountered in pregnancy, most notably large solitary follicle cyst of pregnancy and puerperium, as well as cystic granulosa cell tumors, especially the juvenile variant, which may also present during pregnancy. Of particular use in differentiating them from juvenile granulosa cell tumor is the absence of pale or vacuolated cytoplasm and solid growth of granulosa cells in cases of hyperreactio luteinalis.
黄体反应过度是一种罕见的疾病，主要发生在妊娠期间和妊娠相关滋养细胞疾病（如绒毛膜癌、葡萄胎）中，其特征通常为双侧卵巢因大量卵泡囊肿而增大。虽然这种现象是良性的，并且在分娩或治疗后会自行消退，但在进行卵巢切除术或囊肿切除术以排除恶性肿瘤或处理扭转等急性并发症时，可能会在病理标本中发现。这些切除标本可能与囊性颗粒细胞瘤具有重叠的显微镜特征。因此，我们回顾了 10 例妊娠相关黄体反应过度的病例，这是迄今为止最大的病理队列，以强调该疾病的显著特征。患者年龄在 22 至 30 岁之间。大多数患者（n=6）在剖宫产时因偶然发现卵巢肿块就诊。3 例患者在产后期间就诊，1 例患者因单侧卵巢肿块于 28 孕周行手术治疗。卵巢大小为 8.5 至 29cm，8 例为双侧多房性。组织学检查显示多个大小不一的囊性卵泡，由颗粒细胞层和具有明显嗜酸性细胞质的卵泡膜细胞组成。间质水肿通常很明显，卵泡膜细胞偶尔以巢状、索状和水肿灶中的单个细胞形式出现。有丝分裂通常在颗粒细胞层中更为常见（平均每高倍视野 2.6 个），而在卵泡膜细胞层中更为常见（平均每高倍视野 1 个）。本系列研究记录了黄体反应过度与妊娠期间遇到的其他形成肿块的良性病变（最显著的是妊娠和产褥期的大单发滤泡囊肿，以及囊性颗粒细胞瘤，尤其是妊娠期间也可能发生的幼年型）之间的关键特征，有助于将其区分开来。在将其与幼年型颗粒细胞瘤区分开来时，特别有用的是黄体反应过度病例中颗粒细胞缺乏苍白或空泡状细胞质和实性生长。
