theca lutein cyst

Theca lutein cysts (TLC), also known as hyperreactio luteinalis (HL), are a type of functional ovarian cysts. They are typically multiple and seen bilaterally.

Pathology

They are thought to originate due to excessive amounts of circulating gonadotrophins such as beta-hCG. Hyperplasia of the theca interna cells is the predominant characteristic on histology. The ovarian parenchyma is often markedly edematous and frequently contains foci of luteinized stromal cells.

Associations

Other reported associations include:

Radiographic features

The clinical context is vital in correct imaging interpretation.

General

The cysts are usually large (2-3 cm) and the ovaries often have a typical multilocular cystic appearance across all imaging techniques .

Ultrasound

Bilateral enlarged, multicystic ovaries. The cysts are classically thin walled and have clear contents. There is large amount of solid component which is possibly the residual ovarian stroma.

MRI

Typically seen as bilateral (occasionally unilateral) ovarian enlargement with multiple cysts which are generally of uniform size.

The residual parenchyma within the enlarged ovaries have been reported to show

  • T1 C+ (Gd): intense contrast enhancement
  • T2: intermediate signal intensity
  • DWI: high signal 

Treatment and prognosis

Following evacuation of a molar pregnancy, the associated theca lutein cysts resolve by 2-4 months.

There are cases reported of nomal pregnancies associated with hyperreactio leutinalis which have resolved gradually post delivery.

Surgical emergency is only if ovarian torsion occurs.

Differential diagnosis

For large multiple bilateral ovarian cysts consider

See also