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10.5005/jp-journals-10033-1307
Osseous Metaplasia of Endometrium: A Very Rare Entity
CaSe RepORt

Osseous Metaplasia of Endometrium: A Very Rare Entity

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1 Garima Gupta, Divya Mahindru, Aparajita D’Souza, Sunita Goyal
ABSTRACT It appears in women of reproductive age, though it has
Introduction: Osseous metaplasia of endometrium is a rare been reported in menopausal women as well. A history
disorder characterized by the presence of mature or immature of previous pregnancy is reported in more than 80%
bone in the endometrium. The rarity of the case and high prob- of the cases. A history of abortion, either spontaneous
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ability of missing out, which may lead to delay in appropriate or therapeutic, is the hallmark of this condition. It can
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treatment, makes this case of interest.
also be related to transformation of mesenchymal tissue
Case report: A 37-year-old lady, married for 10 years P2L2 to bone in response to inflammation and the reparative
with previous two lower-segment cesarean section, presented process induced by abortion.
to the gynecology outpatient department with complaints
of secondary infertility for past 7 years, irregular menstrual Most cases present with secondary infertility follow-
cycles, dysmenorrhea, and dyspareunia. Her general exami- ing an abortion or chronic endometritis. Some patients are
nation and bimanual exploration were normal. On ultrasonog- asymptomatic, while others have menstrual irregulari-
raphy, an echogenic foci was seen casting posterior acoustic ties or menorrhagia. Ultrasound examination showing
shadow. On diagnostic laparohysteroscopy, multiple small
coral-like white plaques–bony spicules were seen. They characteristic hyperechogenic pattern of osseous tissue
were removed using hysteroscopic forceps and submitted for within the uterus helps suspect the diagnosis. The final
histopathological study. A histological diagnosis of osseous diagnosis is confirmed by hysteroscopy and removal of
metaplasia of endometrium was made. She is on follow-up the bony tissue by curettage. Complete removal of the
for infertility treatment.
bony spicules from the endometrial cavity by hysteros-
Conclusion: Endometrial ossification is a rare finding, which copy usually cures the patient.
can be misdiagnosed and requires higher degree of suspicion
to diagnose the condition properly. Hysteroscopy has been
shown to be effective in the diagnosis and treatment of cases CASE REpORT
of osseous metaplasia of the endometrium associated with A 37-year-old lady married for 10 years P2L2 with previ-
infertility.
ous two lower-segment cesarean section presented to the
Keywords: Hysteroscopy, Infertility, Osseous metaplasia. obstetrics and gynecology outpatient with complaints of

How to cite this article: Gupta G, Mahindru D, D’Souza A, secondary infertility for past 7 years, irregular menstrual
Goyal S. Osseous Metaplasia of Endometrium: A Very Rare cycles with intermenstrual bleeding. She presented with
Entity. World J Lap Surg 2017;10(2):69-72. history of dysmenorrhea and dyspareunia.
Source of support: Nil Her general examination and bimanual exploration
were normal. Her routine hematological parameters
Conflict of interest: None were normal. Both couples were subjected for infertility

workup and nothing abnormal was noted.
INTRODUCTION Ultrasound pelvis showed the uterus to be of 5.2 ×

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Osseous metaplasia of endometrium is a rare disorder 4.3 cm size with normal shape, and echotexture. Endo-
characterized by the presence of mature or immature metrial stripe was 7.5 mm. An echogenic foci was seen
bone in the endometrium. It is a rarely encountered condi- casting posterior acoustic shadow. Cervix was normal
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tion, with an estimated incidence of 3/10,000. Nearly 80 with closed internal os. Bilateral ovaries were normal. No
cases have been reported in the world literature, including adnexal mass or free fluid was noted in pouch of douglas.
around 9 cases from India. 3 She was taken up for diagnostic laparoscopy and
chromohysteroscopy. On laparoscopy, uterus was found
to be bulky with normal bilateral tubes and ovaries.
1 Assistant Professor, Resident, Professor Chromopertubation test showed bilateral free spill, sug-
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1-4 Department of Obstetrics and Gynecology, Christian Medical gestive of patency of both fallopian tubes.
College & Hospital, Ludhiana, Punjab, India Hysteroscopy was done using rigid hysteroscope with
Corresponding Author: Garima Gupta, Assistant Professor saline as distending media and multiple small coral-like
Department of Obstetrics and Gynecology, Christian Medical white plaques – bony spicules were seen. They were
College & Hospital, Ludhiana, Punjab, India, e-mail: amity removed using hysteroscopic forceps and submitted for
garima@gmail.com
histopathological study (Fig. 1).
World Journal of Laparoscopic Surgery, May-August 2017;10(2):69-72 69