MANAGEMENT AND HISTOPATHOLOGICAL FINDINGS OF AN ATYPICAL PLACENTAL SITE NODULE IN A UTERINE NICHE POST-MULTIPLE CESAREAN SECTIONS: A CASE REPORT AND REVIEW OF LITERATURE

Abstract

Uterine niche, a cesarean scar defect, is an iatrogenic complication following cesarean sections, often asymptomatic but associated with complications like abnormal uterine bleeding, pelvic pain, and reduced fertility. This case report describes a 33-year-old woman with a history of three cesarean sections presenting with chronic pelvic pain and intermenstrual bleeding for three years post her last cesarean. Diagnostic imaging, including transvaginal ultrasound and MRI, revealed a uterine niche with significant myometrial thinning. Hysteroscopy confirmed the defect, and laparotomy facilitated complete excision and repair of the niche. Histopathological examination identified an atypical placental site nodule (APSN), prompting beta-HCG surveillance due to potential malignancy risks. The patient remained asymptomatic during a six-month follow-up, with negative beta-HCG levels and normal ultrasound findings. This case highlights the importance of comprehensive imaging, surgical intervention, and histopathological evaluation in managing symptomatic uterine niches, particularly with atypical findings like APSN. It underscores the need for long-term follow-up to monitor healing and prevent obstetric complications in future pregnancies.