A Rare Case Report: Atypical Endometrial Hyperplasia and Combination of Placental Site Nodule and Treatment Follow-up

Placental site nodules are benign, non-neoplastic lesions, usually seen incidentally in the pathology results of curettage materials, cervical biopsies or hysterectomy materials of women of reproductive age.It originates from intermediate trophoblasts at the implantation site.Although it is a benign lesion, its histopathological distinction from trophoblastic and other malignant neoplasms is important.A 32-year-old female patient, who had given vaginal birth twice before and who had no history of abortion, consulted with the complaint of vaginal bleeding lasting for a month.In transvaginal ultrasonography, the endometrium was 17 mm, the irregularity and thickness increase.Beta human chorionic gonadotropin (β-hCG) test result was negative.Fractional curettage (F&C) was performed.It was reported as "Hyalinized stroma fragments (consistent with placental site nodule) showing atypical endometrial hyperplasia and trophoblastic cell proliferation".Primolut-N three times a day was prescribed.The patient wanted to keep her fertility the for continuing with medical treatment was decided.A new medicine, Megace 160 mg twice a day was prescribed.The control pathology result was reported as "Hyalinized stroma fragments showing trophoblastic cell proliferation (consistent with placental site nodule).The lesion in 4 focus, the largest of which was 2 mm and the others were 1 mm in diameter and showed P63 and PLAP positive staining with the applied immunohistochemical method.Ki67 proliferation index is 2-3%".Close follow-up was planned for the patient every 6 months.Our case report is the first in the literature in terms of the association of atypical endometrial hyperplasia and placental site nodule.In a female of reproductive age who presents with the complaint of excessive vaginal bleeding that does not follow pregnancy, β-hCG should be checked, previous pregnancy or miscarriage history should be questioned, in case of negative results, a benign lesion, a placental site nodule, should be included in the differential diagnosis.