Abstract Background Pregnancy complicated with endometrial atypical hyperplasia, which is often observed billy joel the stranger shirt during early pregnancy, is extremely rare.Case presentation The patient was a 30-year-old woman who had premature delivery at 30+ 1 weeks gestation, and endometrial atypical hyperplasia was discovered by placental examination.Conclusions For patients who undergo fertility-sparing treatment for endometrial atypical hyperplasia, the evaluation of the decidua via the placental pathological copyright tiki mug examination is particularly important.These examinations make a great clinical contribution to the early detection and diagnosis of endometrial atypical hyperplasia.