A 24-year-old female pati...

A 24-year-old female patient with no significant history of surgery had a normal pregnancy and gave birth to a baby weighing 3300 grams in December 2020. In January 2021, she began taking a contraceptive that contained progesterone. However, in February 2021, she visited the emergency room due to abnormal, mild uterine bleeding. A diagnosis of proliferative endometrium was made, which contradicted the effects of progesterone-based therapy. Consequently, the woman was tested for a new pregnancy, and the results were positive. As the patient continued to experience mild uterine bleeding, an ultrasound was performed, revealing heterogeneous images suggestive of leftover placental tissue, although a new miscarriage could not be ruled out. At this point, the patient's β-HCG levels were measured at 198 mIU/ml. In March 2021, scraping biopsies were conducted to confirm the diagnosis. The analysis revealed multiple irregular fragments showing a proliferation of intermediate trophoblast cells. These cells were characterized by large, darkly stained nuclei, cytoplasm that appeared reddish or slightly pink, and occasional instances of cell division (1-2 mitosis in 10 high-power fields). These elements tended to separate the muscle fibers of the uterus and invade the walls of blood vessels, leading to ruptures, bleeding, and tissue death. No chorionic villi were detected. By this time, the patient's β-HCG levels had dropped to 105 mIU/ml, and no hPL (human placental lactogen) was found in the blood analysis. Total hysterectomy and salpingectomy were performed (Fig. 1)