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Case Reports
. 2023 Oct 10;59(10):1803.
doi: 10.3390/medicina59101803.

Endometrial Osseous Metaplasia-A Rare Cause of Infertility with Unknown Etiology

Vlad Iustin Tica  1 , Iulia Postolache  2 , Madalina Boșoteanu  3 , Mariana Aschie  4 , Irina Tica  5 , Cristian Ionut Orasanu  4 , Roxana Cleopatra Penciu  1 , Andrei Adrian Tica  6   7 , Liliana Steriu  1 , Rudy Leon De Wilde  8 , Oana Sorina Tica  7   9
Affiliations
Case Reports

Endometrial Osseous Metaplasia-A Rare Cause of Infertility with Unknown Etiology

Vlad Iustin Tica et al. Medicina (Kaunas). .

Abstract

Background: Osseous tissue in the endometrium is a rare find, and it is most often discovered when the patient presents with infertility. It is frequently associated with dysmenorrhea and abnormal menstrual bleedings. Although its etiology remains unclear, in almost all described cases until now, the patient has an obstetrical history. Case report: In this report, we present a unique case of endometrial osseous metaplasia in a 27-year-old primary infertile patient. The transvaginal ultrasound revealed a 18/13/7 mm hyperechoic endometrial mass with posterior acoustic shadowing and no flow on color Doppler. A hysteroscopic examination found a polygonal calcification on the endometrial posterior face of the uterine cavity, in the corporeal isthmic region, which was extracted. The histopathological evaluation revealed microscopic elements compatible with endometrial calcification. The patient had a good postoperative course and the complex endocrinologic, immunologic and electrolytical investigation failed to prove any abnormality. Follow-up transvaginal ultrasound examinations revealed no modifications. Three years later, the patient conceived spontaneously, had an uneventful pregnancy and delivered a full-term fetus. Conclusion: We assumed that this entity can be a serious cause of infertility since the patient had a long history of (primary) infertility and its resection made the pregnancy's occurrence possible. Finally, since neither history of abortion or chronic inflammation nor any abnormal laboratory test were noticed, we concluded that the etiology of this entity remained unclear.

Keywords: endometrial calcification; osseous metaplasia; primary infertility.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Ultrasound image of intrauterine calcification.
Figure 2
Figure 2
Hysteroscopic view of the uterine cavity, revealing the calcification (panoramic view).
Figure 3
Figure 3
Hysteroscopic view of intrauterine calcification (detail).
Figure 4
Figure 4
Resected intrauterine calcification.
Figure 5
Figure 5
Basophilic acellular material, including glandular epithelial fragments (H.E.; ×40).
Figure 6
Figure 6
CD138 immunostaining.
Figure 7
Figure 7
Brown-black aspect of the amorphous deposits (von Kossa ×40).
Figure 8
Figure 8
PAS-negative reaction of the unstructured calcium depositions (×40).
Figure 9
Figure 9
An ultrasound sagittal view of the fetus of 13 weeks and 2 days.
See this image and copyright information in PMC

References

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