A hard cervix: Microscopic examination revealed that a rare transformation had occurred

Osseous Metaplasia of the Cervix: A Rare Transformation Can Mimic a Tumor-Literature Review

Background

The transformation of nonosseous soft tissue into bone is known as osseous metaplasia (OM). This condition most commonly affects the musculoskeletal and central nervous systems and it is a well-known phenomenon in different soft tissue organs. Rarely, OM can affect the uterus, which can extend into the cervix. OM affecting the cervix alone is a more rare condition that has multiple different clinical presentations. The presentation can be similar to that of a tumor in extremely rare cases.

Case Summary

A 23-year-old nulligravida was complaining of irregular vaginal bleeding for one-month duration. Speculum examination revealed a foul-smelling bloody purulent discharge, tender cervix, and a brownish growth located at the posterior cervical lip. A punch biopsy of the growth was performed. Histological examination of the tissue revealed multiple bone fragments with necrosis and an inflammatory exudate. Because of the unusual findings, a repeat biopsy was performed. The biopsy yielded the same findings, which confirmed the diagnosis of osseous metaplasia of the cervix.

Conclusion

Although osseous metaplasia is a known phenomenon in different soft tissues, it is extremely rare in the uterine cervix and can mimic malignancy. Therefore, clinicians should be aware of it.

Osseous metaplasia of the cervix: A rare transformation

Although numerous cases of endometrial osseous metaplasia appear in the literature, only 6 cases of osseous metaplasia of the cervix have been reported since 1982. A 30 years old nulligravida women was referred to our colposcopy clinic with cervical mass. General, gynecologic and colposcopic assessments were done. The patient had an excision biopsy. Diagnosis of cervical osseous metaplasia was confirmed on histologic examination. The cervical epithelium has the potency to differentiate to multiple types of epithelium including osseous epithelium.

A postconization hematometra revealed a rare case of endocervical bone metaplasia

BACKGROUND

Hematometra is an unusual occurrence in young women undergoing conization; moreover, osseous metaplasia of the uterine cervix is a very rare event, with 7 cases in the literature. A postconization hematometra due to endocervical ossification is a unique occurrence. The authors report such an event.

CASE

A young woman undergoing conization developed progressive hypoamenorrhea with pelvic pain. Pregnancy test was negative and a transvaginal ultrasound showed an image of suspected hematometra. Diagnostic hysteroscopy showed an endocervical obstruction due to a bone formation of the uterine cervix, which was removed with an office operative hysteroscopy. After surgery, the patient restored normal menstrual cycle. Histological examination revealed a cervical bone metaplasia.

CONCLUSIONS

In premenopausal women undergoing conization, the appearance of a progressive hypoamenorrhea with pelvic pain could suggest a cervical mechanical obstruction that could be an uncommon stenosis. Despite this case represents a very rare event, a postconization hematometra due to an endocervical ossification can be managed with an office operative hysteroscopy.