OP13.03: A diagnosis with a concealing outfit

36 years old parous patient had presented at the acute gynaecology unit with intermenstrual bleeding. She had one Caesarean in the past followed by normal vaginal delivery. When she was scanned initially, a mass was seen anterior to lower anterior uterine wall measuring 23 × 15 × 35 mm over her previous Caesarean scar. A diagnosis of haematoma communicating with endometrial cavity and an impression of anterior wall defect post Caesarean section was made. She then had laparoscopy and hysteroscopy. The findings were multiple adhesions and a haematoma tracking from the anterior abdominal wall to the superior edge of bladder peritoneum. Haematoma was not drained in view of its close proximity to the bladder. Patient was managed conservatively with hormonal treatment. As patient continued to bleed, hysterectomy was performed as per patient's request since the symptoms were affecting her quality of life. Post hysterectomy, histological diagnosis of placental site nodule was made. Placental site nodule is thought to represent incomplete involution of implantation site within the endometrium. Most often reported in women 27 to 45 years of age with common presentation of abnormal bleeding. It is commonly diagnosed on histopathology either in endometrial currettings or hysterectomy specimens. Grossly these nodules are described as firm yellow excrescence in endometrium or as haemorrhagic material in upper cervical canal as seen in our case report. We believe it has arisen secondary to previous caesarean delivery because it was found above the scar where there was marked thinning of myometrium to create tracking haematoma which was being confused with endometriosis initially. Though thought to be a benign condition as per our review of the literature, it is also of note that only case reports have been reported in the past. Not much is known about the follow up of these cases of placental site nodules. Placental site nodule/plaque has to be kept in mind as a differential, while seeing patients presenting with inter-menstrual bleeding especially after an intrauterine gestation.