title: Extrauterine placental site trophoblastic tumour in association with a lithopedion.
abstract: OBJECTIVE
  We describe an unusual case of extrauterine placental site trophoblastic tumour located in pouch of Douglas in association with a lithopedion.
  
  
  RESULTS
  A 35-year-old female presented with acute abdomen and peritonitis following rectal perforation. The patient gave a history of 5 months amenorrhoea followed by vaginal bleeding 5 years prior to admission. At laparotomy, a lithopedion was found in pouch of Douglas with rectal perforation and peritonitis. The lithopedion was removed, rectal perforation was sutured and a colostomy was performed. The colostomy was closed later and tumour was seen in the colostomy wound as well as attached to the lithopedion removed previously. The patient presented with a repeated episode of rectal perforation and the tumour had spread to colon, small intestine, omentum, mesentery and right ovary.
  
  
  CONCLUSIONS
  A high-grade malignant placental site trophoblastic tumour with aggressive clinical course occurred at an extrauterine site. It complicated calcified abdominal pregnancy and resulted in repeated rectal perforation and peritonitis.
authors.affiliation: Department of Pathology, PARAS Central Hospital, Sakaka, Al Jouf, Kingdom of Saudi Arabia. imadum12@hotmail.com
authors.forename: I A
authors.initials: IA
authors.lastname: El Hag
authors.forename: K
authors.initials: K
authors.lastname: Ramesh
authors.forename: S M
authors.initials: SM
authors.lastname: Kollur
authors.forename: M
authors.initials: M
authors.lastname: Salem
mesh_terms: D000328:Adult; D002114:Calcinosis / Q000209:etiology / Q000473:pathology*; D004312:Douglas' Pouch / Q000293:injuries / Q000601:surgery; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000473:pathology / Q000601:surgery; D010532:Peritoneal Diseases / Q000209:etiology / Q000473:pathology; D011247:Pregnancy; D011269:Pregnancy, Abdominal / Q000150:complications / Q000473:pathology*; D018245:Trophoblastic Tumor, Placental Site / Q000150:complications / Q000556:secondary* / Q000601:surgery; D014594:Uterine Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery