Endometrial ossification

Endometrial osseous metaplasia complicated by secondary infertility: a case report

Endometrial osseous metaplasia is a rare condition in which there is abnormal presence of bone in the endometrium. There is paucity of reported cases of this pathological condition in Africa and it is usually overlooked as a cause of infertility. Pathogenesis is not well understood but mostly occurs following pregnancy. Pathology may be suspected on ultrasound scan where a linear echogenic substance is seen in the endometrium but diagnosis is confirmed by and treated with hysteroscopy. We present a case of a 43-year-old woman with 2 previous miscarriages who presented with secondary infertility. She had an ultrasound scan done which revealed features suggestive of an intra-uterine copper device. She subsequently had hysteroscopy and a bone-like foreign body was found in the endometrium which was removed with the aid of a grasper and later sent for histopathological evaluation for which a subsequent diagnosis of endometrial osseous metaplasia was made. Indeed, endometrial intraosseous metaplasia should be considered an important differential cause of secondary infertility especially in patients with history of previous miscarriage. Confirmatory diagnosis can be made through hysteroscopy and/or histopathologically although the former is now used.

Calcified Leiomyomata Presenting as Recurrent Pregnancy Loss

Recurrent spontaneous abortion (RSA) is a problem that faces women for a variety of reasons. Although leiomyomata is relatively common, calcified leiomyomata which is called “womb stones” is a very rare cause of RSA. These womb stones are correlated with retained products from conception and osseous metaplasia. We report a very rare case of a large calcified leiomyomata which caused secondary infertility and pregnancy loss of 7 pregnancies due to spontaneous abortions.

Endometrial osseous metaplasia: Clinicopathological study of a case and literature review

Endometrial osseous metaplasia is an uncommon clinical entity with the presence of bone in the endometrium. Most of the cases clinically present with secondary infertility following an abortion. Various theories have been proposed and the most accepted theory is metaplasia of the stromal cells into osteoblastic cells that produce the bone. It is important to distinguish this condition from the mixed mullerian tumor of the endometrium to avoid hysterectomy. Removal of these bony bits leads to spontaneous conception. We present one such case in a 25-year-old female patient presented with secondary infertility.

Osseous metaplasia of the endometrium associated with infertility: a case report and review of the literature

Introduction

Endometrial ossification is an uncommon disease related to secondary infertility and its etiology and pathogenesis are controversial. More than 80% of reported cases occur after pregnancy.

Case presentation

A 33-year-old Caucasian woman was admitted with a history of secondary infertility and with a regular menstrual cycle. She reported a miscarriage at 12 weeks of gestation 7 years previously and subsequent dilatation and curettage in another medical facility. Vaginal ultrasound was performed and showed an intrauterine structure described as a hyperechogenic image suggesting calcification related to chronic endometritis. Office hysteroscopy revealed a wide endometrial cavity and proliferative endometrium, with a coral-like white plaque 1.5 cm in length on the right horn and posterior wall of the uterus. The lesion was treated by hysteroscopy without complications. Microscopic examination showed endometrial tissue with osseous metaplasia in the stroma. Nine months after the procedure, the patient became pregnant spontaneously.

Conclusion

In our patient, hysteroscopy was effective in the diagnosis and treatment of osseous metaplasia of the endometrium associated with infertility.

Demonstration of multipotent stem cells in the adult human endometrium by in vitro chondrogenesis

Stem cells are defined by their unique capacity for self-renewal and multilineage differentiation. Stem cells have been obtained from multiple extramedullary tissues. Recently, a population of progenitor cells have been identified in the endometrium. However, multilineage differentiation of endometrial stem cells has not been reported. Endometrial tissue was obtained from reproductive-aged women undergoing surgery for benign disease, from which monolayer endometrial stromal cell (ESC), myometrial, fibroid, fallopian tube, and uterosacral ligament tissue cultures were generated. Once confluent, cells were trypsinized and centrifuged in conical tubes to form a cell pellet. Cell pellets were cultured in a defined chondrogenic media (CM) containing dexamethasone and transforming growth factor (TGF)-beta2 or TGF-beta 3 for 3 to 21 days. Samples were analyzed for markers of human articular cartilage, including sulfated glycosaminoglycans and expression of type II collagen. ESC pellets cultured in CM were found to contain cells that resemble chondrocytes. These cells expressed sulfated glycosaminoglycans and type II collagen typical of human articular cartilage. Myometrial, fibroid, fallopian tube, and uterosacral ligament cells were unable to undergo chondrogenic differentiation using the pellet culture method. Cells derived from the endometrium were able to differentiate into a heterologous cell type: chondrocytes, thus demonstrating the presence of multipotent stem cells. Endometrium is a potential source of multipotent stem cells.

Lifetime expression of stem cell markers in the uterine endometrium

OBJECTIVE

To identify stem cells in uteri from the fetal to the postmenopausal period.

DESIGN

Descriptive, controlled study.

SETTING

Tertiary academic medical center.

PATIENT(S)

Forty archived uterine endometrial samples.

INTERVENTION(S)

Immunohistochemistry with c-kit/CD117, CD34, bcl-2, and Ki67.

MAIN OUTCOME MEASURE(S)

Immunostaining.

RESULT(S)

C-kit/CD117, CD34, bcl-2, and Ki67 were consistently expressed in the stroma of the basalis layer. Bcl-2 was restricted to the fetal uterine endometrium.

CONCLUSION(S)

By studying the immunolocalization of stem cell markers (i.e., c-kit, CD34, and bcl-2), we found that stem cells are present continuously in the uterine endometrium from the fetal period. The cells seem to be located mainly in the stroma of the basalis and to be independent of hormonal regulation to avoid cyclic shedding. A small number of latent stem cells dormant in the stroma of the basalis were found to have the potential for mesenchymal differentiation.

Histologic characterization of rat ovarian carcinoma induced by intraovarian insertion of a 7,12-dimethylbenz[a]anthracene-coated suture: common epithelial tumors of the ovary in rats?

BACKGROUND

The surface epithelium of the human ovary simulates the mullerian form in tumor formation. In experimental animals, however, such a phenomenon has not previously been observed.

METHODS

A chemical carcinogen, 7,12-dimethylbenz[a]anthracene (DMBA), was heated, and the central portion of a 3-0 silk suture was immersed in the melted carcinogen. After vaginal cytology, the DMBA-coated silk was inserted into the ovaries of 40 Wistar strain rats age 7 weeks. The animals were sacrificed when a tumor mass became large enough to extend the abdominal wall. The experimental period lasted for 60 weeks. The tumor histology was compared with that in human counterparts and the mullerian derivatives in rats.

RESULTS

In 19 rats, including 4 animals with cornified vaginal smears at the time of DMBA treatment, an ovarian carcinoma developed within 36 weeks. In 17 epithelial tumors, the neoplastic cells proliferated to form papillary or glandular structures, and the lining epithelium consisted of flattened or cuboidal cells and columnar cells, often with pseudostratified nuclei. Adenocarcinoma components transformed into squamous cells in two cases. The remaining two neoplasms were pure mesenchymal tumors with histology of a fibrosarcomatous tumor, and one of them contained heterologous malignant osteoid components. In the remaining 21 rats, including 5 with cornified smears, no tumors developed during the experimental period.

CONCLUSIONS

The histologies of DMBA-induced rat ovarian carcinoma simulated the epithelia of rat ovarian surface, fallopian tube, endometrium, and uterine cervix. The results of this study suggest that the surface epithelium of rat ovary also simulates the mullerian form in tumor formation.

Endometrial pathology and infertility

OBJECTIVE

To call attention to endometrial pathologies, which in addition to causing menstrual problems, are a cause of infertility.

DESIGN

Controlled clinical study.

SETTING

Specialized unit in the management of infertile patients.

PATIENT(S)

Fifteen infertile women between the ages of 26 and 39 years and suffering infertility from endometrial problems for a period of 4 to 18 years were included in the study. Six patients had primary infertility and nine others had secondary infertility.

INTERVENTION(S)

Once the endometrial pathology was diagnosed, treatment was initiated according to the type of problem: hysteroscopy, curettage, and hormonal replacement with or without corticoids or antiphymic drugs.

MAIN OUTCOME MEASURE(S)

Clinical studies, laboratory tests, hormonal serum levels, and endoscopy.

RESULT(S)

After initiating specific treatment for each of the pathologies, menstruation was re-established in 14 of 15 patients. Nine patients became pregnant (8 of 10 cases with bone, squamous cell, or muscular metaplasia).

CONCLUSION(S)

Pathological changes of the endometrium are causes of infertility. These problems are not as rare as thought. They must be searched for carefully and diagnosed promptly. The majority carry a good prognosis when adequately treated.

Endometrial ossification associated with secondary infertility

A patient with secondary infertility and endometrial ossification after a spontaneous is described. The aetiology and pathogenesis of endometrial ossification are discussed.