Theca lutein cyst

Last revised by Magdi Mahsoub on 21 Jan 2025

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

They have a very high association with gestational trophoblastic disease.

Other reported associations include:

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.

The clinical context is vital in correct imaging interpretation.

The cysts are usually large (2-3 cm) and the ovaries often have a typical multilocular cystic appearance across all imaging techniques 4.

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.

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 6:

  • T1 C+ (Gd): intense contrast enhancement

  • T2: intermediate signal intensity

  • DWI: high signal 

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

There are reported cases of normal pregnancies associated with hyperreactio leutinalis that resolved gradually post delivery.

Surgical emergency is only if ovarian torsion occurs.

For large multiple bilateral ovarian cysts consider:

Cases and figures

  • Case 1: with concurrent invasive mole
  • Case 2: with complete hydatidiform mole
  • Case 3: with ovarian cyst torsion
  • Case 4

Imaging differential diagnosis

  • Ovarian hyperstimulation syndrome
  • Ovarian mucionous neoplasm
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