The interval from the most recent known pregnancy till the time of detection ranges widely from one month to 8 years with an average of 3 years. Placental site nodule (PSN) represents remnants of placental site tissue that has failed to involute and may remain in the uterus for several years after the pregnancy from which it resulted. A spectrum of lesions derived from the intermediate trophoblast have been described, placental site nodule or plaque, exaggerated placental site reaction, placental site trophoblastic tumor and epithelioid trophoblastic tumor. Gestational trophoblastic disease constitutes a diverse group of lesions, which also includes neoplastic and non-neoplastic proliferations of trophoblast unaccompanied by chorionic villi. Later followup ultrasound also showed complete resolution. The patient underwent dilatation and curettage under anesthesia. Hysteroscopy was not available at the time of procedure (Figure 1, Figure 2, Figure 3 and Figure 4).įigure 4a and Figure 4b: Intermediate trophoblastic cells have small round nucleus with clear cytoplasm, with some large cells exhibiting irregular hyperchromatic nuclei and occasional. She underwent dilatation and curettage under spinal anesthesia and adequate endometrial tissue was obtained under ultrasound guidance which shows near complete evacuation of the residual tissue. She was advised for complete evacuation under anesthesia. After receiving the report as PILL ENDOMETRIUM with PLACENTAL SITE NODULE. She was subjected to dilatation and curettage on day care procedure and endometrial sample was sent to histopathological analysis. Hence patient was advised for dilatation and curettage for further analysis. Ultrasonographic evaluation showed thickened endometrium measuring 15 mm in thickness. General physical examination and routine gynaecological checkup were normal, hormonal profile and pap smear were normal serum beta HCG was negative. One year she had lactational amenorrhea after which she had irregular bleeding with menorrhagia from 6 months. She had puerperal abdominal tubectomy immediately after delivery. Her eighth pregnancy was uneventful and she delivered normally at term. She gave a history of undergoing dilatation and curettage after her 5 th abortion in view of retained products. Ī 29-yrs-old female patient para 3, living 3, abortion 5, underwent laprotomy and tubectomy 2 yrs back presented with history of irregular menstrual cycles with menorrhagia since 6 months preceded by normal cycles. PSN needs to be differentiated from aggressive lesions of intermediate trophoblast like placental site trophoblastic tumor and epithelioid trophoblastic tumor and from nontrophoblastic diseases like squamous cell carcinoma. Infertility is a rare mode of presentation in PSN. These lesions are discovered as incidental findings in curettage or hysterectomy specimens performed for evaluation of irregular uterine bleeding, abnormal cervical smears, post coital bleeding etc. Although PSN occurs in the reproductive age group, a temporal association with recent pregnancy is usually lacking and often the time interval between pregnancy and diagnosis of PSN can be several years. Placental site nodule (PSN) is a rare, benign lesion which represents remnants of intermediate trophoblast from a previous gestation that has failed to completely involute. Timely diagnosis and treatment is necessary to differentiate it from potentially malignant placental lesions with a similar presentation. PSN is an uncommon condition which should be suspected in cases of abnormal bleeding, especially following uterine surgical procedures preceding last pregnancy. Follow ups of typical PSNs do not show recurrence or malignant potential. PSN is benign, but it is important to distinguish it from the other benign and malignant lesions like decidua, placental polyp, exaggerated placental site and placental site trophoblastic tumor and squamous cell carcinoma. PSN usually presents as menorrhagia, intermenstrual bleeding or an abnormal pap smear. Placental site nodule is an uncommon, benign, generally asymptomatic lesion of trophoblastic origin, which may often be detected several months to years after the tenancy from which it resulted.
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