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CASE REPORT
Year : 2013  |  Volume : 16  |  Issue : 3  |  Page : 127-129

Bilateral massive corpus leteum cysts in a human immunodeficiency virus positive singleton pregnancy at term


Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Date of Web Publication22-Nov-2013

Correspondence Address:
Panti Abubakar Abubakar
Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching Hospital, PMB 2370, Sokoto
Nigeria
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DOI: 10.4103/1118-8561.121925

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  Abstract 

Corpus luteum cyst at term is a rare occurrence. It is unusual for these cysts to be bilateral. We report a case of massive bilateral corpus luteum cysts in a term singleton pregnancy. A 32-year-old gravid 2, para 1, known human immunodeficiency virus positive patient on highly active antiretroviral therapy had an elective cesarean section at term on account of a low CD4 count and ovarian cysts. At surgery, she was found to have massive bilateral ovarian cysts. Each of the cysts was about the size of a 20-week size gravid uterus, (Left side 20 cm × 23 cm×15 cm; Right side 22 cm × 24 cm ×10 cm). After the 3.4 kg male baby was delivered in a good condition, a bilateral cystectomy was performed. Subsequent histopathology confirmed the diagnosis of corpus luteum cyst of pregnancy.

Keywords: Corpus luteum cysts, human immunodeficiency virus, singleton pregnancy, term


How to cite this article:
Abubakar PA, Sadiya N, Suleiman B, Joel O. Bilateral massive corpus leteum cysts in a human immunodeficiency virus positive singleton pregnancy at term. Sahel Med J 2013;16:127-9

How to cite this URL:
Abubakar PA, Sadiya N, Suleiman B, Joel O. Bilateral massive corpus leteum cysts in a human immunodeficiency virus positive singleton pregnancy at term. Sahel Med J [serial online] 2013 [cited 2021 Jul 31];16:127-9. Available from: https://www.smjonline.org/text.asp?2013/16/3/127/121925


  Introduction Top


The corpus luteum is formed during the luteal phase of ovarian cycle. The natural history is either to regress such as a corpus albicans in the absence of pregnancy or to continue until the complete maturation of the placenta by the end of first trimester. [1] Corpus luteum cysts are functional and most of them completely disappear spontaneously [1] though they can persist throughout the pregnancy. Corpus luteum cysts are the most common adnexal masses in pregnancy, but they seldom exceed more than 6 cm in diameter. [2]

We report here the case of a 32-year-old woman with bilateral massive corpus luteum cysts in a singleton pregnancy at term.


  Case Report Top


A 32-year-old, gravida 2, para 1, abortus 0, alive 1 woman pregnancy was spontaneously conceived and there was no use of ovulation inducing drugs. She was booked for antenatal care at 33 weeks gestational age. Her booking weight and height was 83.3 kg and 1.72 m respectively. She was diagnosed to be human immunodeficiency virus (HIV) positive during routine screening at booking. Her CD4 count was 80 cell/ul, while her viral load was 36450 copies/ml. Other investigation results were normal. The ultrasound result showed a singleton normal fetus at 33 weeks plus 5 days gestation with bilateral huge multiseptate cysts containing clear fluid.

The patient was commenced on highly active antiretroviral therapy and was seen regularly at the antenatal clinic. The pregnancy was uneventful. She was admitted for cesarean section at 38 weeks because of the huge bilateral ovarian cysts and a high viral load.

First, a lower segment cesarean section was performed at surgery. We explored the abdominal cavity and found a giant left ovarian cyst (20 cm × 23 cm × 15 cm) and a giant right ovarian cyst (22 cm × 24 cm × 10 cm). Both ovaries was smooth walled, multiloculated and without solid elements, and was replaced by multiple cysts of varying size [Figure 1]. We considered that they were benign cysts. After a live male infant (3.4 kg) was delivered in a good condition, the patient received bilateral cystectomy [Figure 2]. Some cysts ruptured during the cystectomy but the unruptured cysts weighed 2.82 kg.
Figure 1: Gross appearance of the bilateral multiseptate ovarian cysts at surgery. The left cysts had partially ruptured

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Figure 2: Gross appearance of both ovaries after cystectomy

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Subsequent histopathology showed a huge cystic cavity lined by plump luteinized cells in keeping with corpus luteum cyst [Figure 3].
Figure 3: Microscopic examination showed a huge cystic cavity lined by plump luteinised cells in keeping with corpus luteum cyst

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The patient's post-operative course was unremarkable. Her CD4 count and viral load at 6 weeks follow-up was 150 cell/ul and 22,210 copies/ml respectively.


  Discussion Top


In pregnancy the corpus luteum does not regress but becomes even larger to form the corpus luteum of pregnancy. Not infrequently it has a large cystic component which regresses after the first trimester when the placenta takes over its function. [3] The occurrence of a bilateral corpus luteum cyst at term singleton pregnancy is rare and this could be the first documentation. The case of bilateral corpus luteum cysts had been reported in multiple pregnancy. [4] Its report in singleton pregnancy was only reported in a cow. [5]

Corpus luteum is self-limiting after delivery. However, it can be complicated by torsion, [6] hemorrhage, [7] or rupture. [8] Our patient was however uncomplicated and was monitored closely during pregnancy to term. The patient was offered cystectomy since the cysts appear clinically benign though a frozen section diagnosis of the ovary would have been a more reasonable approach before taking such a decision it would have guided us whether or not a removal of the ovary should be performed. However, since we do not have facilities for a frozen section and also putting into consideration the need to preserve the patient's ovarian function because of her age we decided to perform a cystectomy.

The contribution of our patients HIV status, low CD4 count and a high viral load to the course of corpus luteum is uncertain. This is a subject that may be addressed by further research.

 
  References Top

1.Hibbart LT. Corpus luteum surgery. Am J Obstet Gynecol 1979;135:666.  Back to cited text no. 1
    
2.Hill LM, Johnson CE, Lee RA. Ovarian surgery in pregnancy. Am J Obstet Gynecol 1975;122:565-9.  Back to cited text no. 2
[PUBMED]    
3.Haddad A, Mulvany N, Billson V, Arnstein M. Solitary luteinized follicle cyst of pregnancy. Report of a case with cytologic findings. Acta Cytol 2000;44:454-8.  Back to cited text no. 3
[PUBMED]    
4.Teng LS, Jin TK, Feng HK, Zhu TM, Zhao F, Gangjin Z. Bilateral Massie ovarian lutean cyst in a twin pregnancy. J Med Assoc 2010;73:644-6.  Back to cited text no. 4
    
5.Assey RJ, Kessy BM, Matovelo JM. Bilateral multiple ovarian cysts in a pregnant zebu cow. Vet Rec 1997;140:288-9.  Back to cited text no. 5
[PUBMED]    
6.Hibbart LT. Adnexal torsion. Am J Obstet Gynecol 1985;152:456-61.  Back to cited text no. 6
    
7.Takeda A, Sakai K, Mitsui T, Nakamura H. Management of ruptured corpus luteum cyst of pregnancy occurring in a 15-year-old girl by laparoscopic surgery with intraoperative autologous blood transfusion. J Pediatr Adolesc Gynecol 2007;20:97-100.  Back to cited text no. 7
    
8.Hallatt JG, Steele CH Jr, Snyder M. Ruptured corpus luteum with hemoperitoneum: A study of 173 surgical cases. Am J Obstet Gynecol 1984;149:5-9.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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