背景:本研究旨在探讨影像学特征,妊娠黄体瘤的临床特点及新生儿结局。
方法:回顾性分析2003年1月至2022年12月中山大学附属第一医院收治的妊娠黄体瘤患者。我们记录了他们的影像特征,临床特征和新生儿结局。此外,我们回顾了该领域的相关研究。
结果:总计,已确认127例,包括我们医院的8个和文献的119个。大多数患者(93/127,73.23%)为生育年龄,20-40岁,66%的人是parous。产妇多毛症或男性化(如声音加深,痤疮,面部毛发生长和阴蒂肿大)观察到29.92%(38/127),而59.06%(75/127)的患者无症状。据报道,13例患者因压迫引起腹痛,扭转或合并异位妊娠。怀孕的黄体瘤,主要在妊娠晚期发现(79/106,74.53%),直径从10毫米到20厘米不等。剖宫产或产后输卵管结扎术中偶然发现75例,39例通过孕期影像学检查或体格检查确诊.约26.61%的患者有双侧病变。大多数妊娠性黄体瘤为实体和明确的(94/107,87.85%),43.06%(31/72)显示多个实性和界限清楚的结节。在多毛症或男性化患者中观察到血清雄激素水平升高(达到足月妊娠正常值的1.24至1529倍),病变直径较大(P<0.001),双侧病变患病率较高(P<0.001)。在男性化母亲所生的女婴中,68.18%(15/22)被病毒化。22例影像特征信息完整。超声检查显示19例中有12例(63.16%)的低回声实性肿块,血供丰富。9例患者接受了磁共振成像(MRI)或计算机断层扫描(CT),六个展示出固体肿块,包括三个多结节固体块。
结论:妊娠黄体瘤主要表现为明确的,低回声和高血管实性肿块。MRI和CT在显示多发结节的影像学特征方面优于超声检查。母亲的男性化和影像学上有多个结节的实性肿块可能有助于诊断这种罕见疾病。
BACKGROUND: This study aimed to investigate the imaging features, clinical characteristics and neonatal outcomes of pregnancy luteoma.
METHODS: We retrospectively analyzed patients with pregnancy luteoma admitted to the First Affiliated Hospital of Sun Yat-sen University between January 2003 and December 2022. We recorded their imaging features, clinical characteristics and neonatal outcomes. Additionally, we reviewed relevant studies in the field.
RESULTS: In total, 127 cases were identified, including eight from our hospital and 119 from the literature. Most patients (93/127, 73.23%) were of reproductive age, 20-40 years old, and 66% were parous. Maternal hirsutism or virilization (such as deepening voice, acne, facial hair growth and clitoromegaly) was observed in 29.92% (38/127), whereas 59.06% of patients (75/127) were asymptomatic. Abdominal pain was reported in 13 patients due to compression, torsion or combined ectopic pregnancy. The pregnancy luteomas, primarily discovered during the third trimester (79/106, 74.53%), varied in size ranging from 10 mm to 20 cm in diameter. Seventy-five cases were incidentally detected during cesarean section or postpartum tubal ligation, and 39 were identified through imaging or physical examination during pregnancy. Approximately 26.61% of patients had bilateral lesions. The majority of pregnancy luteomas were solid and well-defined (94/107, 87.85%), with 43.06% (31/72) displaying multiple solid and well-circumscribed nodules. Elevated serum androgen levels (reaching values between 1.24 and 1529 times greater than normal values for term gestation) were observed in patients with hirsutism or virilization, with a larger lesion diameter (P < 0.001) and a higher prevalence of bilateral lesions (P < 0.001). Among the female infants born to masculinized mothers, 68.18% (15/22) were virilized. Information of imaging features was complete in 22 cases. Ultrasonography revealed well-demarcated hypoechoic solid masses with rich blood supply in 12 of 19 cases (63.16%). Nine patients underwent magnetic resonance imaging (MRI) or computed tomography (CT), and six exhibited solid masses, including three with multi-nodular solid masses.
CONCLUSIONS: Pregnancy luteomas mainly manifest as well-defined, hypoechoic and hypervascular solid masses. MRI and CT are superior to ultrasonography in displaying the imaging features of multiple nodules. Maternal masculinization and solid masses with multiple nodules on imaging may help diagnose this rare disease.