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Unexpected discovery of fetal bones instead of an intrauterine device: A unique gynecological case report. SAGE Open Med Case Rep 2024; 12:2050313X241249628. [PMID: 38756329 PMCID: PMC11097719 DOI: 10.1177/2050313x241249628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 04/06/2024] [Indexed: 05/18/2024] Open
Abstract
This case report details an unusual and unexpected finding in a 37-year-old woman with a history of two cesarean sections, who had an intrauterine device implanted. The patient presented with symptoms of abnormal uterine bleeding and dysmenorrhea. An initial ultrasound confirmed the presence of the intrauterine device. However, a startling discovery was made during the intrauterine device removal procedure: fetal bones were found within the patient. This case underscores the importance of thorough diagnostic evaluations in gynecological practice, particularly when dealing with patients who have complex gynecological histories. Significantly, it brings to light the necessity of employing hysteroscopy for comprehensive diagnostic assessment in cases of abnormal uterine bleeding post-abortion. This approach could aid in identifying rare and unexpected findings, such as retained fetal bones, which might be missed by conventional ultrasound. The report emphasizes the need for vigilance and thoroughness in gynecological examinations and contributes to the understanding of potential complications and anomalies associated with intrauterine device usage and post-abortion care.
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Imaging of endometrial osseous metaplasia—an uncommon but treatable cause of infertility. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2020. [DOI: 10.1186/s43043-020-00045-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Endometrial osseous metaplasia (EOM) is an uncommon condition characterised by metaplastic transformation of endometrial tissue into osteoblasts (mature or immature bone in the endometrium). Etiopathogenesis of EOM is explained by multiple putative mechanisms like dystrophic calcification, metaplastic ossification, retained foetal bones after abortions and genito-urinary tuberculosis. EOM has varied clinical presentation ranging from patient being asymptomatic to secondary infertility. Although hysteroscopy is the gold standard for its diagnosis and treatment, non-invasive imaging comprising chiefly of ultrasonography (USG) is increasingly becoming the mainstay of diagnosis. We aim to present the imaging findings in EOM to acquaint radiologists and gynaecologists with this condition to avert misdiagnosis of this uncommon yet treatable cause of infertility.
Results
Mean age of patients was 31.4 ± 5.4 (S.D) years. USG revealed linear or tubular densely echogenic endometrium with posterior acoustic shadowing in all the 14 patients. MRI in 3 patients revealed diffuse or patchy areas of T1W and T2W hypointense signal intensity with unilateral (n = 2) and bilateral (n = 1) ovarian cysts. One patient who underwent CT scan revealed dense endometrial calcification. Histopathologic examination (HPE) revealed lamellar (n = 6) or trabecular (n = 4) bone within endometrium (EOM) and inflammatory cells with calcification in four patients (calcific endometritis). Twelve patients conceived after dilatation and curettage within 15 months.
Conclusion
Familiarity with the imaging appearances of EOM is indispensable to clinch this diagnosis and avert misdiagnosis of this rare but potentially treatable cause of infertility. USG is usually sufficient for diagnosis. MRI and CT are only supplementary tools in difficult clinical scenarios.
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Calcified Leiomyomata Presenting as Recurrent Pregnancy Loss. Case Rep Obstet Gynecol 2020; 2020:2921472. [PMID: 32908742 PMCID: PMC7450328 DOI: 10.1155/2020/2921472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/11/2020] [Indexed: 11/18/2022] Open
Abstract
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.
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Retained Intrauterine Bony Fragments as a Cause of Secondary Infertility in a Tertiary Level Indian Hospital. J Hum Reprod Sci 2018; 11:286-290. [PMID: 30568360 PMCID: PMC6262664 DOI: 10.4103/jhrs.jhrs_33_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Midtrimester surgical abortions often result in retained intrauterine fetal bones and consequent secondary infertility. Aim To study the incidence of women presenting with retained intrauterine bones as a cause of secondary infertility in a tertiary level Indian hospital and pregnancy rates following retrieval of these fragments. Setting and Design Retrospective data analysis in the infertility clinic of PGIMER (Post Graduate Institute of Medical Education and Research), a tertiary level hospital of Northern India. Materials and Methods Women diagnosed with retained intrauterine bony fragments were subjected to hysteroscopic removal of these fragments. Incidentally diagnosed retained bones on hysteroscopy were also removed. Such women were followed for spontaneous resumption of fertility or were subjected to ovulation induction, and pregnancy rates were noted. Results Retained fetal bones accounted for 0.28% of all women with infertility and 12% (22/144) of all the uterine causes of infertility requiring an operative hysteroscopic procedure for treatment. Only 5 (27.7%) of 18 women conceived after the hysteroscopic retrieval of bony fragments: three had full-term vaginal deliveries, one had a midtrimester abortion, and one woman is in her third trimester. Conclusion Despite surgical retrieval, fertility rates may be lower due to inflammatory damage to the endometrium.
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Endometrial osseous metaplasia-a rare presentation of polymenorrhagia: a case report. J Clin Diagn Res 2015; 9:QD07-8. [PMID: 26023606 PMCID: PMC4437122 DOI: 10.7860/jcdr/2015/12221.5844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/20/2015] [Indexed: 11/24/2022]
Abstract
Endometrial ossification is a rare entity in which bones are found in the uterus. Exact aetiopathogenesis is not known but the most accepted theory is metaplasia of stromal cells into osteoblast cells result in the formation of bones. The possibility of malignant mixed mullerian tumour should be in the mind of clinician and pathologist while making diagnosis. We hereby report an extremely rare case, which is among very few reported cases in the world, in which endometrial ossification presented in a perimenopausal female with polymenorrhagia. A 41-year-old multiparous patient presented with irregular bleeding per vaginum for the past two years. She was found to be a case of endometrial calcification with osseous metaplasia with presence of bones varying from 7mm - 1.5 cms size in the uterine cavity. She was successfully managed by total abdominal hysterectomy.
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Fetal Bone Remnant as a Cause of Abnormal Uterine Bleeding. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2013.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Endometrial osseous metaplasia: Clinicopathological study of a case and literature review. J Hum Reprod Sci 2011; 3:102-4. [PMID: 21209755 PMCID: PMC2970784 DOI: 10.4103/0974-1208.69329] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 01/07/2010] [Accepted: 03/19/2010] [Indexed: 11/30/2022] Open
Abstract
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.
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Abstract
Osseous metaplasia of the endometrium is very rare finding, and usually these cases presented with secondary infertility. Other symptoms are pelvic pain, dyspareunia, menstrual irregularities, vaginal discharge and the passage of bony fragments in menstrual blood. Suspicious lesion could see by hysterosalpingography or by ultrasonography; however, conclusive diagnosis and treatment tool is hysteroscopy. The aetiology is unknown, but theories include retained fetal bone and osseous metaplasia of endometrial tissue. We present a patient with osseous metaplasia who had treated with hysteroscopy.
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[Fertility after endometrial osseous metaplasia elective hysteroscopic resection]. ACTA ACUST UNITED AC 2010; 38:460-4. [PMID: 20579919 DOI: 10.1016/j.gyobfe.2010.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 03/12/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The endometrial osseous metaplasia is a rare disease which is characterized by the presence of osseous tissue in endometrium. It is often diagnosed in women with secondary infertility. The main objective of this work is to evaluate fertility after elective resection of osteoid metaplasia endometrial lesions by operative hysteroscopy in infertile women. PATIENTS AND METHOD Retrospective and descriptive series of 7 cases observed in the Woman and Child department, CHU Jean-Verdier. The 7 women were in reproductive age, of African origin, with secondary infertility after abortions concerning 6 out of the 7 patients. RESULTS In all cases, endovaginal pelvic ultrasound has raised endometrial calcification, and diagnostic hysteroscopy highlighted endometrial osteoid metaplasia. The operative hysteroscopic procedure consisted of elective diathermic resection to handle endometrial insertion of bone chips. A second diagnostic hysteroscopy was systematically done. It showed no recurrence. Six of the 7 patients began pregnancy, 3 spontaneously and 3 after IVF/ICSI in the first year following the hysteroscopic treatment. The evolution of pregnancies has been marked by 2 normal deliveries, 1 spontaneous miscarriage and then an ectopic pregnancy in one patient, 1 growth retardation intrauterine requiring caesarean at 38 SA, 1 HELLP syndrome in a twin pregnancy requiring ceasarean at 27 SA followed normal labor at term and 1 pregnancy lost sight. DISCUSSION AND CONCLUSION Hysteroscopic elective resection seems to be the treatment of choice with a good prognosis on subsequent fertility.
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Abstract
Retention of intrauterine fetal bone is a rare cause of secondary infertility that should be considered when ultrasound demonstrates strongly shadowing echodensities in the endometrial space. It seems that the bone acts as an intrauterine contraceptive device as long as it is present in the cavity. Hysteroscopy is both diagnostic and therapeutic, with a generally good prognosis for future fertility in the absence of coexisting factors.
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Retained fetal bones masquerading as an intrauterine device with missing threads. EUR J CONTRACEP REPR 2010; 15:213-5. [PMID: 20210525 DOI: 10.3109/13625181003675239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We present the case of a 26-year-old woman with retained fetal bones, discovered eight years after an induced mid-trimester abortion in a West African country. The patient had requested her general practitioner to change the intrauterine device (IUD) which she assumed had been inserted immediately post-abortion. No threads were seen on vaginal examination. A pelvic ultrasound examination showed features that were misinterpreted for an IUD in the cervical canal. At evacuation of the uterine cavity retained fetal bone fragments were recovered.
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Osseous metaplasia of the endometrium associated with infertility: a case report and review of the literature. J Med Case Rep 2009; 3:7427. [PMID: 20687904 PMCID: PMC2827176 DOI: 10.4076/1752-1947-3-7427] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2008] [Accepted: 02/19/2009] [Indexed: 11/17/2022] Open
Abstract
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.
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Abstract
The endometrium is central to mammalian fertility. The endometrial stromal cells are very dynamic, growing and differentiating throughout the estrous cycle and pregnancy. In humans, stromal cells appear to have progenitor or stem cell capabilities and the cells can even differentiate into bone. It is not clear whether bovine endometrial stromal cells exhibit a similar phenotypic plasticity. So, the present study tested the hypothesis that bovine endometrial stromal cells could be differentiated along an osteogenic lineage. Pure populations of bovine stromal cells were isolated from the endometrium. The endometrial stromal cell phenotype was confirmed by morphology, prostaglandin secretion, and susceptibility to viral infection. However, cultivation of the cells in standard endometrial cell culture medium lead to a mesenchymal phenotype similar to that of bovine bone marrow cells. Furthermore, the endometrial stromal cells developed signs of osteogenesis, such as alizarin positive nodules. When the stromal cells were cultured in a specific osteogenic medium the cells rapidly developed the characteristics of mineralized bone. In conclusion, the present study has identified that stromal cells from the bovine endometrium show a capability for phenotype plasticity similar to mesenchymal progenitor cells. These observations pave the way for further investigation of the mechanisms of stroma cell differentiation in the bovine reproductive tract.
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Endometrial osseous metaplasia: an evolving cause of secondary infertility. Fertil Steril 2008; 90:2013.e9-11. [DOI: 10.1016/j.fertnstert.2008.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 01/02/2008] [Accepted: 01/02/2008] [Indexed: 11/26/2022]
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Osseous metaplasia: Case report and review. Fertil Steril 2004; 82:1433-5. [PMID: 15533373 DOI: 10.1016/j.fertnstert.2004.04.055] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Revised: 04/29/2004] [Accepted: 04/29/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To discuss, through the experience of a case report and extensive literature review, the best practices for the diagnosis and treatment of osseous metaplasia, which is the cause of secondary infertility. DESIGN Case report. SETTING In vitro fertilization unit in Athens. PATIENT(S) A 40-year-old woman with a 10-year history of secondary infertility. INTERVENTION(S) Hysteroscopic diagnosis and removal of the bony fragment. MAIN OUTCOME MEASURE(S) Elimination of secondary infertility caused by osseous metaplasia. RESULT(S) After treatment, the woman underwent an IVF program and a healthy neonate was born with cesarean section. CONCLUSION(S) Hysteroscopy remains the best practice for the diagnosis and removal of endometrial ossifications, causing secondary infertility.
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Uterine intramural bone after mid-trimester termination of pregnancy may not affect fertility: a case report. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 22:407-408. [PMID: 14528479 DOI: 10.1002/uog.220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We present a case of a 27-year-old asymptomatic woman, gravida 2 para 0 abortus 2, diagnosed with uterine intramural fetal bone 30 days after a mid-trimester termination of pregnancy (TOP) by dilatation and evacuation (D&E). On ultrasound part of a fetal spine was seen within the right lateral isthmocervical area, adjacent to the descending branch of the uterine artery. Within 4 months after TOP the patient conceived again. This case illustrates the risk of myometrial penetration during mid-trimester TOP by D&E. Removal of intramural bony fragments may not be needed in an asymptomatic patient, as their presence does not seem to compromise fertility.
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Bony fragments in the uterus: an association with secondary subfertility. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 22:402-406. [PMID: 14528478 DOI: 10.1002/uog.221] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Bone within the uterine cavity is an unusual finding in women with secondary subfertility, and is usually associated with a past history of termination of pregnancy. The etiology is unknown, but theories include retained fetal bone and osseous metaplasia of endometrial tissue. We describe the cases of three subfertility patients, all with a history of surgical termination of pregnancy. Each patient underwent a hysteroscopy after highly echogenic foci were seen in the uterus on transvaginal ultrasound examination. During hysteroscopy, several coral-like bony fragments were seen and removed by sharp curettage. On histological examination, these fragments were found to be mature, necrotic bone. This case report confirms the importance of routine baseline evaluation of the endometrium in subfertile women with a history of termination of pregnancy.
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Recurrent Osseous Metaplasia of the Cervix After Loop Electrosurgical Excision. Obstet Gynecol 2001. [DOI: 10.1097/00006250-200111001-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Favorable pregnancy outcome in a woman with osseous metaplasia of the uterus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2000; 15:445-446. [PMID: 10976492 DOI: 10.1046/j.1469-0705.2000.00105.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Subfertility due to osseous metaplasia of the endometrium treated by hysteroscopic resection. ACTA ACUST UNITED AC 2000. [DOI: 10.1054/cuog.2000.0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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FOETAL BONES CAUSING SECONDARY INFERTILITY. Med J Armed Forces India 1998; 54:282-283. [DOI: 10.1016/s0377-1237(17)30570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
A case of endometrial ossification in a 62 year old woman is reported. The patient presented with increased vaginal discharge. On transvaginal ultrasonography, a hyperechoic area within the uterine cavity, suggestive of an intrauterine foreign body, was noted. Histological examination of the endometrial curettage showed mature bone with neutrophilic infiltration. There was no evidence of malignancy. Endometrial ossification in postmenopausal women is very rare; most women presenting with this condition are between 20 and 40 years of age. Therefore, clinicians should consider the possibility of endometrial ossification as a differential diagnosis of intrauterine foreign body on ultrasound, even in older patients. In addition, pathologists should be aware of this rare entity to avoid a misdiagnosis of malignant mixed müllerian tumor in the endometrial curettage specimen, which may result in unnecessary hysterectomy.
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Abstract
A case of secondary infertility, dysmenorrhoea and menorrhagia due to retained fetal bone is presented. Retained fetal bones should be considered in all patients with infertility, dysfunctional uterine bleeding, dysmenorrhoea or other symptoms dating from a pregnancy or pregnancy termination. Ultrasound is an excellent modality for evaluating these patients. Ultrasound is also very useful for the follow-up of patients after surgical removal of the bony fragments. Some bony fragments may be embedded in the endometrium or myometrium and may not be identified at curettage. Hysteroscopy is valuable in both establishing the diagnosis and the removal of bony fragments. A crucial aspect of the procedure involves reintroduction of the hysteroscope to document that the cavity is clear after attempts at bone removal are complete. After removal of bony fragments, restoration of fertility and improvement of symptoms are expected.
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Abstract
BACKGROUND Endometrial ossification is a rare condition. The common feature in most reported cases is a previous history of abortion and retention of fetal bones. Few cases of endometrial ossification can be explained by osseous metaplasia. Clinical presentation may include abnormal vaginal bleeding or discharge, dysmenorrhoea, pelvic pain, and secondary infertility. Hysterectomy or dilation and curettage have been the usual therapeutic methods used. Recently, some cases have been treated by means of hysteroscopic resection. CASE We report a case of endometrial ossification in a woman who presented with dysmenorrhoea, dyspareunia and pelvic pain. The patient had a pregnancy voluntarily terminated at 16 weeks. Five subsequent routine annual gynaecological exams, including ultrasonographies, were normal. A new gestation was also voluntarily terminated at 6 weeks. One month later the patient started with clinical manifestations. Ultrasonograms performed 4 months after the second abortion revealed a strong uterine echogenic band. Bone tissue was successfully removed by hysteroscopic resection. CONCLUSION This case adds further evidence favouring new bone formation in the uterus as a pathogenic mechanism for endometrial ossification and illustrates the feasibility of hysteroscopic treatment for this condition.
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Osseous metaplasia of the endometrium: Two case reports. J OBSTET GYNAECOL 1996. [DOI: 10.3109/01443619609004105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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