Retained Placenta Accreta Mimicking Choriocarcinoma

Abstract

This case demonstrates a rare event of retained invasive placenta masquerading as choriocarcinoma. The patient presented with heavy vaginal bleeding following vaginal delivery complicated by retained products of conception. Ultrasound and computed tomography demonstrated a vascular endometrial mass, invading the uterine wall and raising suspicion for choriocarcinoma. Hysterectomy revealed retained invasive placenta.

Figure 1

Gray-scale US demonstrates an echogenic mass in the endometrial cavity (black arrow).

Figure 2

Color Doppler US image demonstrates vascularity in the echogenic mass with extensive vascularity surrounding the mass.

Figure 3

Contrast-enhanced CT image demonstrates hypervascular uterine mass. Note loss of plane between the mass and the uterine wall (white arrow).

Figure 4

CT image of the chest demonstrates ground glass opacities in the lungs (open arrows).

Figure 5

Grossly retained placenta with microscopic evidence of placenta accreta. (a) Gross photograph of hysterectomy specimen bisected in coronal plane shows ~12 × 11 × 3 cm fundal placenta (outlined in dashed lines) with ~3.5 cm umbilical cord (outlined in solid lines) (arrows at cervical os, ∗ = leiomyoma). (b) Hematoxylin and eosin stained microscopic section demonstrates degenerating placental villous parenchyma [villi] adjacent to large bands of myometrial smooth muscle [myo] without intervening decidua [MA = maternal myometrial artery]. Scale bars: (a) 1 cm and (b) 100 microns. Note: due to extensive tissue degeneration at the placenta/myometrial interface, the depth of accreta could not be accurately determined on pathologic examination.