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Background
Placental site nodule (PSN) is a rare diagnosis.
We would like to raise awareness of this condition which presents like any other common pathology, so that early diagnosis and prompt treatment can lead to resolution of symptoms.
Atypical PSN can potentially progress to placental site trophoblastic tumour (PSTT) and epithelial trophoblastic tumour.
Case presentation
A 28-year-old woman, para 2, with a history of polycystic ovarian syndrome, presented with a 1 year history of menometrorrhagia and intermenstrual spotting starting 2 months after a full term normal delivery. Following her first delivery, she had undergone manual removal of the placenta (MRP) and had postpartum haemorrhage requiring blood transfusion.
She opted for surgical termination of her second pregnancy. The third pregnancy was uneventful and she delivered normally at term. Following that, she developed irregular menstrual cycles with heavy bleeding and intermenstrual spotting.
Clinical examination, hormonal profile and Pap smear were normal.
Investigations
Ultrasonographic evaluation showed a 9 mm thick heterogeneous, irregular endometrium with slight increase in vascularity. Hysteroscopy ( figure 1 ) showed a normal appearing endometrium with a 2 cm polyp which was removed. Histology confirmed PSN along with a normal secretory endometrium ( figure...