Hysteroscopic Findings of Placental Site Nodule (PSN). A Case Report

The hysteroscopic findings of placental site nodule, an unusual and cytologically alarming lesion, is reported. A 29-year-old woman, para 2, presented with a 3 month history of intermenstrual bleeding. The last spontaneous delivery occurred 12 months previously. Pelvic examination was negative. Ultrasound examination revealed increased thickness and irregularity of the endometrium (16-18 mm). Diagnostic hysteroscopy performed the same day revealed the endometrial surface to be irregular due to a focal nodular lesion with increased regular vascularization in the fundal area. The nodule was about 2 cm in diameter, had an irregular surface and a variegated appearance, and was white-red in color with hemorrhagic and necrotic areas. A targeted biopsy of the lesion was performed. Histologic examination revealed a "placental site nodule." A subsequent D&C confirmed the diagnosis. Fifteen days after surgery, hPL and hCG serum levels were evaluated and were negative. This is the first hysteroscopic report of a placental site nodule. We conclude that hysteroscopic evaluation of abnormal uterine bleeding is very important, because it allows the examination of the uterine cavity and lesions, making possible a guided biopsy. Hysteroscopy is also useful during the follow-up of this type of pathology.