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We report the diagnostic and therapeutic debate raised by an ectopic pregnancy on a cesarean scar. There were three phases. The first was to differentiate between an ongoing abortion and an ectopic pregnancy on a cesarean scar. The second was to determine whether the tissue was a mass of persistent trophoblasts or an invasive mole. Finally to determine the nature of a residual mass after chemotherapy and normalization of the beta CG level.

The morphological criteria for the diagnosis of endocervical atypia and dysplasia are variably defined. Diagnosis is difficult. MIB-1 (Ki-67) cell proliferation-associated antigen was detected retrospectively by immunohistochemistry in 230 cervical cone specimens. The percentage of MIB-1 positive cells was 1 to 25% (median 2%) and limited to small hot spots in normal and subnormal glands (140 cases). It was 1 to 30% (median 4%) in endometrioid metaplasia and microglandular hyperplasia (55 cases); 30 to 60 (median 40%) and limited to 1-3 glands in atypia (24 cases); 45 to 60% (median 50%) and diffusely distributed in dysplasia (5 cases). In situ (3 cases) and invasive (3 cases) adenocarcinomas were characterized by a high% (> 60) of MIB-1 positive cells.