BACKGROUND AND IMPORTANCE: Placental site trophoblastic tumor (PSTT) a rare form of gestational trophoblastic disease, originates from intermediate trophoblastic cells and presents with nonspecific symptoms, complicating diagnosis. PSTT primarily affects women of childbearing age, but occurrences in perimenopausal women are exceptionally rare. CASE PRESENTATION: We report a case of a 54-year-old perimenopausal woman presenting with a two-month history of abnormal uterine bleeding. Clinical and imaging evaluations revealed an enlarged uterus and an intracavitary mass. Elevated β-hCG levels prompted suspicion of a trophoblastic tumor. Histopathological examination confirmed PSTT. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy as definitive treatment. Postoperative outcomes were favorable, with normalization of β-hCG levels and no evidence of recurrence during two years of follow-up. Immunohistochemical staining for HPL and cytokeratin further confirmed the diagnosis. CLINICAL DISCUSSION: This case highlights the importance of integrating clinical, imaging, and histopathological findings for the accurate diagnosis of PSTT. Unlike other gestational trophoblastic neoplasms, PSTT is characterized by low sensitivity to chemotherapy, making surgical management the cornerstone of treatment. Long-term follow-up is essential to monitor for potential recurrence. CONCLUSION: PSTT is a rare and diagnostically challenging condition, particularly in atypical presentations such as in perimenopausal women. Early and accurate diagnosis, followed by surgical intervention, is critical for favorable outcomes. This case emphasizes the need for heightened clinical awareness and a multidisciplinary approach in managing such rare conditions.