We report a rare case of endometrial ossification in a 28 year old female, who presented with abdominal pain, menorrhagia and secondary infertility. On transvaginal ultrasonography, a hyper-echoic area within the uterine cavity, suggestive of an intra-uterine foreign body was noted. Histopathological examination of the endometrial curettage showed bony spicules with inflammatory cells infiltration. There was no evidence of malignancy. Introduction Endometrial osseous metaplasia, an uncommon entity which is related to secondary infertility following an abortion, is the presence of mature and immature bone in the endometrium. Less than 100 cases have been reported in the world literature, including nine from India [1],[2],[3].. Most of the patients conceive after the hysteroscopic evacuation of the bony spicules [4],[5]. We are reporting a case of endometrial ossification in a 28 year old female, who presented with menorrhagia and secondary infertility. Case Summary A 28 year old female patient presented to Gynecological Out Patient Department with the complaints of abdominal pain, menorrhagia and secondary infertility. Her past history revealed that she had one living child and two repeated abortions 6 years back, after which she had failed to conceive. Dilatation and curettage was done at 4 months of gestation during the last conception. The patient had no known history of systemic disease. The patient had no signs or laboratory findings which suggested a calcium metabolism disorder. Her serum calcium and phosphorus levels were normal. Further evaluation by ultrasonography revealed a densely echogenic band occupying most of the endometrial cavity. The patient underwent diagnostic hysteroscopy which revealed a single firm to hard tissue piece within the endometrial cavity, which were removed by using hysteroscopic forceps and these were submitted for histopathological study.Grossly, the biopsy specimen included multiple, small, firm to hard tissue bits, along with scanty soft tissue pieces, together measuring 1×0.5×0.5 cms in dimension.(figure 1) The hard tissue bits were kept for decalcification. The hematoxylin and eosin stained paraffin sections were subjected for microscopic examination. The sections showed fragmented endometrial tissue which was predominantly composed of tubular glands with scanty stroma. The osteoid tissue which was mainly composed of the trabeculae of woven bone was present surrounding the endometrial tissue and inflammatory cells. The endometrial glands did not show any secretory activity. Further examination did not reveal any granuloma, necrosis or the products of conception. The histological diagnosis of osseous metaplasia of the endometrium was made.(figure 2)
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