Background: Gestational trophoblastic neoplasia (GTN) is a rare but highly curable malignancy arising from trophoblastic tissue. Although it predominantly affects women of reproductive age, its occurrence in perimenopausal women is exceptional and often leads to diagnostic delay due to atypical clinical presentation.

Case presentation: We report the case of a 52-year-old gravida 3 para 2 woman, still menstruating, who presented with abnormal uterine bleeding. Clinical examination revealed a cervical mass initially suggestive of a prolapsed submucosal fibroid. Pelvic ultrasound demonstrated a 4 × 5 cm heterogeneous, non-vascularized cervical lesion associated with endometrial thickening. Initial histopathological analysis suggested squamous cell carcinoma. However, markedly elevated serum β-human chorionic gonadotropin (β-hCG) levels (120,000 mIU/mL) led to the diagnosis of GTN. The patient subsequently developed life-threatening hemorrhage requiring emergency hemostatic hysterectomy. Staging investigations showed no metastases, and the FIGO/WHO score was 7, indicating high-risk disease. The patient received adjuvant multi agent chemotherapy with complete biochemical remission.

Conclusion: GTN should be considered in the differential diagnosis of abnormal uterine bleeding and pelvic masses regardless of age. Early measurement of serum β-hCG is essential to avoid misdiagnosis. This case highlights the importance of recognizing atypical presentations and the role of emergency surgery in life-threatening complications.