The incidence of placenta accreta ranges from 1:2500 to 1:7000 births [1,2]. The incidence of placenta percreta has steadily risen over the past several decades [3]. Although improvements in documentation have occurred, an increase in patients with relevant risk factors parallels the increase in incidence. Risk factors for the development of abnormal placentation include: previous cesarean deliveries, placenta previa, maternal age greater than 35 years, high gravidity, multiparity, and previous curettage [1,2]. A 34-year-old woman (gravida 6, para 1) presented for evaluation with the diagnosis of a large vascular uterine mass, 4 months after having a dilation and curettage (DC however, the patient had persistent vaginal bleeding. Serial transvaginal ultrasounds revealed a complex mass seen in the anterior lower uterine segment. Magnetic resonance imaging (MRI) revealed a large pelvic mass with areas of nonenhancement consistent with possible necrosis (Fig. 1). The mass abutted the right pelvic wall, bladder, and rectum, though it did not clearly invade these structures. A computerized tomography (CT) scan showed no adenopathy or extrauterine masses. Differential diagnosis at the time included placental site trophoblastic tumor, persistent placental tissue, or other uterine tumors including a degenerating fibroid. The patient was counseled to undergo an examination under anesthesia, and ultrasound-guided D&C. The βhCG at the time was 3 mIU/mL, and serum human placental lactogen was b0.10 μg/mL. The patient desired fertility preservation, but given the possibility of myometrial invasion, the patient gave informed consent for hysterectomy. A D&C was attempted, however, sonographic guidance revealed that the uterine mass was not clearly contiguous with the endometrial cavity. Exploratory laparotomy was performed which revealed an enlarged, necrotic, hemorrhagic mass measuring 4×6 cm that protruded from the anterior lower uterine segment, and was densely adhered to the bladder. Upon attempted biopsy of the mass, a rapid loss of 500 cm of blood occurred, resulting in a total abdominal hysterectomy. The preliminary intraoperative pathology report was consistent with necrosis and possible placental site trophoblastic tumor. Total operative blood loss was 1000 cm, and the patient's postoperative course was unremarkable. Final pathology revealed extensively necrotic placental tissue extending from the anterior endometrial cavity, through the myometrium to the uterine serosa (Fig. 2). The majority of the placental tissue was extrauterine, consistent with necrotic placenta percreta. In this case, the symptoms of persistent vaginal bleeding and the development of a large vascular uterine mass 4 months following a first trimester D&C were suggestive of malignancy. This patient was at high risk of abnormal placentation, given her history of multiple uterine curettages and one prior cesarean delivery. Placenta percreta can lead to disastrous complications, including uterine rupture, abolished future fertility, and even