placental polyp is a somewhat pedunculated remnant of chorionic tissue retained in the uterine cavity for an indefinite time .
it may result in abnormal uterine bleeding and slightly elevated detectable titers of serum -human chorionic gonadotropin ( hcg ) .
these pedunculated masses of villi are often found within days to weeks following abortion or delivery of a term placenta .
since trophoblastic neoplasms especially placental site trophoblastic tumor may have similar symptoms and signs , it is important to consider placental polyp in differential diagnosis in such situations .
a 34-year - old g4l3ab1 woman came with abnormal uterine bleeding since her last normal vaginal delivery 3 months ago .
serum -hcg level was slightly elevated ranging from 86 to 103 iu / ml during diagnostic investigations .
ultrasonography revealed enlarged uterus with an echolucent intracavitary uterine mass measuring 73 mm  55 mm  24 mm . computerized topography confirmed the presence of the mass and showed no abnormality in thorax .
clinical , laboratory , and imaging findings raised the suspicion of gestational trophoblastic tumors especially those arising from intermediate trophoblastic cells .
macroscopically , the uterus showed slight global enlargement resulting from the presence of a polypoid mass within the endometrial cavity .
the cut surface was diffusely red with some fine streaks of a gray colored tissue .
it was attached to the uterine wall in the fundal region without any macroscopic permeation into the myometrium [ figure 1 ] .
microscopic study showed largely necrotic villi in a network of fibrin deposition [ figures 2 and 3 ] .
a large polypoid mass with smooth outer surface has completely filled the endometrial cavity necrotic chorionic villi are seen in the background of fibrin deposition ( 40 ) nuclear debris are seen in the stroma of necrotic chorionic villi ( 400 )
placental polyp is a fragment of retained placental tissue in the uterus that has undergone neovascularization after resolution of gestation .
chronic uterine inversion due to placental polyp has also been reported . a case of placental
these pedunculated masses of villi are often found within days to weeks following abortion or delivery of a term placenta . rarely , they persist for months or even years after pregnancy .
abnormal uterine bleeding due to placental polyp has been attributed to preserved villi , clusters of destructive villi , and isolated viable cotyledons .
preservation of the brush border of syncytiotrophoblastic cells and the presence of placental phosphatase maintain the anticoagulative properties of villi .
thromboplastic properties of the preserved villi play an important role in the pathogenesis of uterine bleeding when necrotic villi with epithelial remnants are prevalent .
computed tomographic angiography is also useful in diagnosis and management of placental polyp with neovascularization .
magnetic resonance imaging may also be used in diagnosis and follow - up of placental polyps .
. a hypervascular placental polyp may lead to severe hemorrhage that requires blood transfusions , interventional radiology procedures , hysteroscopic resection , and even hysterectomy to control bleeding .
evaluation of neovascularization by multimodal imaging is potentially useful in management of placental polyp in women who wish to preserve fertility .
successful treatment with the use of iliac artery occlusion catheters and concomitant hysteroscopic resection has been reported .
intraoperative injection of prostaglandin f2 followed by hysteroscopic resection has been successful in management of these cases .
serum hcg fell to undetectable level following surgery . although the patient had completed her family and did not have any desire to preserve her fertility , a proper preoperative diagnosis with accurate interpretation of imaging findings and satisfactory curettage would have prevented hysterectomy in this patient .
placental polyp should be considered in any case of parous woman with unexplained abnormal uterine bleeding and slightly elevated serum hcg level .
this does not exclude the possibility of the presence of a placental polyp as the source of abnormal bleeding .
all authors have contributed in designing and preparation of the first draft of the manuscript .
they have read and approved the content of the manuscript and confirmed the accuracy or integrity of any part of the work .
 placental polyp is retained placental tissue within the endometrial cavity , which forms a nidus for inflammation and bleeding . 
 there are very few reported cases of the clinical placental polyp . here 
 , we report a case of 34-year - old g4l3ab1 woman with the chief complaint of intermittent vaginal bleeding since her last normal vaginal delivery 3 months ago . 
 serum human chorionic gonadotropin ( hcg ) titer was slightly elevated . 
 a polypoid mass was detected within the endometrial cavity by imaging studies . 
 history of the patient , mass lesion within the endometrial cavity and slightly elevated serum hcg titer raised the suspicion of trophoblastic neoplasms . 
 endometrial curettage yielded unsatisfactory specimen containing only fibrin deposition and was followed by total hysterectomy . 
 the uterus showed slight global enlargement resulting from the presence of a polypoid mass within the endometrial cavity . 
 the red - colored mass had a smooth outer surface and fragile consistency without any permeation into the myometrium . 
 pathology reported it as the placental polyp . 
 although very rare , placental polyp should be kept in mind as one of the reasons of abnormal uterine bleeding in parous women . 
 definite diagnosis is made by pathology examination . 
INTRODUCTION
CASE REPORT
DISCUSSION
AUTHORS CONTRIBUTIONS