Spontaneous Regression of Large Theca Lutein Cysts in a Twin Pregnancy; A Case Report

Abstract

Fetal ascites has been documented by ultrasound to progressively disappear prior to birth. This report describes a case in a nineteen-year-old in which fetal ascites was documented in the midtrimester of pregnancy and in which subsequent regression was shown by ultrasound. Although non-immune fetal hydrops commonly has a poor prognosis, it is possible to adopt an observant attitude while carefully evaluating for an etiology of fetal ascites.

Case Details

Personal Characteristics

The patient, a 28-year-old black woman, had one previous normal delivery, after which an intrauterine contraceptive device was inserted; this had been removed 5 months previously.

Clinical Characteristics

2-week history of lower abdominal pain and a tender mass in the right side of the abdomen. Examination revealed two masses in the lower abdomen, one on each side of the midline. The uterus was enlarged on bimanual palpation, and a small mobile mass in the right breast was found. The mass had been present for 2 years.

Remission Characteristics

The cysts were approximately the same size at 12 weeks. At 13 weeks they had markedly decreased in size; the right cyst was then 10 x 9 x 5 centimeters and the left 9 x 8 x 5 centimeters. By 14 weeks the cysts were not palpable abdominally and at 22 weeks they could not be detected on ultrasound scanning.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

The patient was observed in the ward over the subsequent weeks and her symptoms gradually subsided. The patient was subsequently followed up as an outpatient.

Additional Notes

The patients 24-hour urinary human chorionic gonadotrophin (HCG) excretion was 89,600, 77,400 and 108,882 IU/24 hours at 10, 12 and 13 weeks; gestation respectively. The growth of the twins was satisfactory and at 26 weeks gestation the patient was readmitted in advanced premature labour and delivered a 990 gram infant and a 1,100 gram infant, neither of which survived. The placenta was normal on macroscopic examination. The cysts were not palpable at this stage.