{"paper_id":"b76faa84-32e9-4afa-b20a-c48dd0d82b25","body_text":"~ 366 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2021; 5(1): 366-367 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2021; 5(1): 366-367 \nReceived: 27-10-2020 \nAccepted: 25-12-2020 \n \nDr. Shazia Nisar \nSenior Resident, Department of \nObstetrics and Gynecology, \nSKIMS, Soura, Srinagar, \nJammu and Kashmir, India \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nDr. Shazia Nisar \nSenior Resident, Department of \nObstetrics and Gynecology, \nSKIMS, Soura, Srinagar, \nJammu and Kashmir, India \n \nOsseous metaplasia of endometrium: A cause of \ninfertility \n \nDr. Shazia Nisar \n \nDOI: https://doi.org/10.33545/gynae.2021.v5.i1f.841 \n \nAbstract \nOsseous Metaplasia of endometrium is a very rare  clinical entity responsible for causing  infertility. It is \nbelieved to be conversation of fibr oblasts to osteoblasts as a result of  chronic inflammation, chro nic \nendometritis, tuberculosis, previous abortion. Patients may be ei ther asymptomatic being detected \nincidentally on USG or it may cause menstrual irregularities with infertility. Diagnosis being made by USG \nand hysteroscopy along with  histopathological examination. Hysteroscopy is diagnostic as well as \ntherapeutic. \nCase report: A 30 year old female with hist ory of menstrual irregularities and primary infer tility. Patient \nhad history of pulmonary tuberculosis in past. Her baseline investigations were normal  she und erwent \ndiagnostic laparoscopy. Endometrial curettage showing osseous Metaplasia. Hysteroscopy was done in this \npatient that was both diagnostic as well as therapeutic. \n \nKeywords: Osseous metaplasia, endometrium, cause of infertility \n \nIntroduction  \nOsseous Metaplasia of Endometrium is a rare clinical entity  that presents with mature o r \nimmature bone in Endometrium. Various theories have been proposed and the most ac cepted \ntheory is Metaplasia of stromal cells into osteoblastic cells  [1, 2, 3]. Although this condition is rare \nwith incidence of 3/10000 [4] but it is a cause of infertility (primary as well as secondary). Most \nof these cases show association with previou s abortion [5] or chronic  endometritis, prolonged \noestrogen exposure, chronic intake of calcium  and vitamin D. Tubercular endometritis can also \nlead to osseous Metaplasia and should be ruled to especially in India  [6]. Diagnosis is made by \nultrasound exami nation of pelvis showing acoustic shadow  suggestive of calcification. \nConfirmation is done by hysteroscopy that  is both diagnostic and therapeutic and improves \nchances of spontaneous conception.  \n \nCase report \nA 30 year old female that presented with irregu lar cycles with oligomenorrhea and \nhypomenorrhea. She was married for 6 years and presented with history  of pulmonary \ntuberculosis in past. The patient reported to me as case of  Primary infertility. She had no history \nof thyroid disorders, galactorrhea. Her general examination and pelvic examination was normal. \nAll investigations we're done in her that included CBC complete blood cou nt, kidney function \ntests KFT, Liver function tests LFT, follicular stimulating hormone  FSH, luteinizing hormone \nLH, anti mullerian hormone AMH, Serum Estradiol, Husband semen analysis, Thyroid function \ntests TFT, serum prolactin, USG pelvic organs. All investigations wer e normal however her \nUSG pelvic organs showed linear bands suggestive of calcification. She was planned for \ndiagnostic Laparoscopy with chromotubation patient refused for hysteroscopy. On laparoscopy \neverything was normal uterus was normal externally, fallopian tubes were normal, there was no \nendometriosis. Dye test was done which was positive on both sides. Endom etrial curettage was \ndone and curettings were send for Histopathological examination and Acid fast bacillus  culture \nwith PCR for tuberculosis. AFB culture and PCR was negative. Histopathological  examination \nfollowing was seen;  Sections studied show multipl e fragmented biopsy showing endometrial \nglands and stroma Glands are small round, tubular and occasional elongated glands lined by \ncolumnar epithelium.  \n \n \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com \n~ 367 ~ \nThere are multiple areas of osseous metaplasia \nShe was further planned for hysteroscopy. Hysterosco py w as \ndone and multiple small bony fragments were found, that were \nremoved by hysteroscopy Uterine cavity was restored to normal. \nPost-operative period was however uneventful. \n \nDiscussion \nOsseous Metaplasia is a very rare clinical entity, only 9 cases \nhave been reported from India [7].  \nIt is also called as intrauterine bone formation, heterotropic bone \nformation, endometrial ossification. Most of the patients present \nas secondary infertility though ours was a case of  Primary \ninfertility, patients may present post abortion or normal delivery \nfollowing which it may take 8 weeks to 10 years for ossification \nto occur. Patients ma y be either asymptomatic or may present \nwith menstrual irregularities with infertility. Long back in year \n1884 Virchow attributed this endometrial ossification to \nspontaneous differentiation of fibroblasts to osteoblasts [8].  \nActually it is believed that chronic inflammation is a precursor \nfor this osseous differentiation.  \nInflammation can be secondary to chronic endometritis, \ntuberculosis, retained products of conception from previous \nabortion [9] The exact mechanism for infertility is believed that \nthis osseous Metaplasia acts as intra uterine contraception device \nthat prevents conception.  \nDifferential diagnosis of osseous Metaplasi a includes \nendometrial tuberculosis, mixed malignant mesodermal tumour \nretained fetal bones after abortion [10]. \nHysteroscopy is both diagnostic as well as therapeutic. \nHysteroscopy can be done laparoscopically to prevent uterine \nperforation in case of ext ensive ossification. Literature has  \nshown good conception rates following hystero scopy that is \nsame in our case. \n \nConclusion \nOsseous Metaplasia though a rare condition can be encoun tered \nin clinical picture which presents as infertility with menstrual \nirregularities. Hysteroscopy being diagnostic as well as  \nTherapeutic. \n \nReferences \n1. Bhatia NN, Hoshiko MG. Uterine oss eous Metaplasia. \nObstet Gynecol 1982;60:256-9.  \n2. Shroff CP, Kudterkar NG, Badhwar VR. Endometrial \nossification-report of three cases with literature review. \nIndian J Pathol Microbiol 1985;28:71-4.  \n3. Waxman M, Mousseuris HF. Endometrial ossification \nfollowing an Abortion. Am j Obstet. Gynecol 1987;130:587-\n8. \n4. Adamson NEJR, Sonmers SC. Endometrial ossification: \nreport of two cases. Am j Obstet. Gynecol 1954;67(1):187-\n190. \n5. Nderoglu LS, Yarali H, Gultekin M, Katlan D.  Endometrial \nosseous Metaplasia : An evolving cause of se condary \ninfertility. Fertil. Steril 2008;90(5);e9-11. \n6. Shroff CP, Kudterkar NG, Badhw ar VR. Endometrial \nossification-report of three cas es with  literature review. \nIndian J Pathol Microbiol 1985;28:71-4. \n7. Singh P, Kapur K, Singla S, Naz N. Endometrial osseous \nMetaplasia and mature bone formation with extra medullary \nhematopoiesis. J Hum Reprod. Sci 2011;4(1):56-57. \n8. Rose-e-Silva JE , Barcelos ID, Navarro PA, Rosa -e-Silva \nACJ, Nogueira AA, Ferriana RA. Osseous Metaplasia of \nendometrium associated with infertility : A case report and \nreview of the literature. J Med case Rep 2009;3:74-27. \n9. Caynela E, Perez -Medina T, Vilanova J, Alejo M, Canada s \nP. True osseous Metaplasia of endometrium: the bone is not \nfrom a fetus. Fertil. Steril 2009;91(4):1293.e1-1293.e4 \n10. Madaan M, Suman S, Sharma R, Kapoor N, Garg P, Raj SS. \nOsseous Metaplasia of endometrium and successful \nhysteroscopic resection: report of two ca ses and a review of \nthe literature. Asian J Endosc Surg 2015;8(1):63-6.","source_license":"CC0","license_restricted":false}