Exaggerated Placental Site Reaction: A Challenging Diagnosis

Gestational trophoblastic disease (GTD) includes both neoplastic and nonneoplastic disorders arising from placental trophoblastic tissue. Among tumor-like conditions, exaggerated placental site reaction (EPSR) is a rare benign condition characterized by the persistence of the normal implantation site reaction following pregnancy. Histologically, it is characterized by diffuse infiltration of intermediate trophoblastic cells into the endometrium and superficial myometrium without features of malignancy. We report a case of EPSR presenting with persistent vaginal bleeding and rising β-hCG levels after first-trimester surgical termination of pregnancy, initially raising suspicion of retained products of conception and abnormal uterine vascularity on imaging. This case highlights the diagnostic challenges of EPSR and the importance of integrating clinical, biochemical, radiological, and histopathological findings to avoid overtreatment.