Hemorrhagic infarction of hyperreactio luteinalis in spontaneously conceived singleton pregnancy: An uncommon cause of late third-trimester ovarian accident

Ovarian masses complicate about 1%–2% of all pregnancies while posing diagnostic and therapeutic challenges. Most are benign tumors but occasionally, functional cysts, such as theca lutein cysts, may be encountered in pregnancy. These are bilateral ovarian masses associated with high levels of β-human chorionic gonadotropin, thus seen mostly in the settings of trophoblastic diseases, multiple gestations, or following treatment for subfertility. It has also been reported in spontaneous singleton pregnancies. Clinical presentation is variable, ranging from asymptomatic conditions discovered incidentally to acute gynecological emergencies due to ovarian accidents. We report the case of a 29-year-old gravida 2, para 1 + 0, with estimated gestational age of 39 weeks plus 1 day, who had a previous emergency lower segment cesarean section (ELSCS) 3 years ago and presented with 1-h history of sudden-onset, sharp, right-sided, abdominal pain of increasing intensity. There were no history of trauma and no evidence of labor. On examination, she was a young gravid woman, at term, in severe painful distress. Baseline investigations were done, and she had ELSCS and exploratory laparotomy with a right salpingo-oophorectomy for twisted and hemorrhagic right adnexa discovered. Pathologic evaluation of the right ovary revealed an enlarged, dark brown, lobulated ovarian mass comprising multiple cortical cysts separated by a thin wall and containing dark brown fluid, with gray brown and hemorrhagic solid areas. A histologic diagnosis of hemorrhagic infarction on the background of multiple theca lutein cysts in pregnancy was made. She had a good postoperative recovery.