Endometrial Osseous metaplasia associated with secondary infertility - Report of 2 cases

Endometrial osseous metaplasia is a rare clinical entity with the presence of mature or immature bone in the endometrium. Nearly eighty cases have been reported in the world literature. It can cause secondary infertility and it occurs in more than eighty percent of patients after an abortion. Here is a report of two cases of secondary infertility who came for evaluation and found to have osseous metaplasia on workup. Case 1- A thirty four years old nulliparous lady, married for six years with history of a spontaneous abortion at eight weeks of gestation. Ultrasound showed small subendometrial and endocervical calcific foci. . Dilatation and curettage was done and endometrial curettings were sent for histopathological examination which revealed foci of heterotopic ossification. Case 2 - A thirty years old nulliparous lady presented with secondary infertility. She gave history of spontaneous abortion at ten weeks of gestation, 4 years back. Ultrasound pelvis revealed a linear hyperechoic area of 8mm length in lower endometrial cavity. Hysteroscopic examination was done and endometrial curettings were taken. The histopathology report showed osseous metaplasia. These case reports highlight peculiar cause of infertility and discusses its management by hysteroscopy. Osseous metaplasia of endometrium is described as an endogenous non-neoplastic pathological condition. Its estimated incidence is 3 out of 10000 people. Heterotopia, dystrophic calcification, ossification of post-abortive endometritis, metastatic calcification, metaplasia in healing tissue, prolonged estrogenic therapy after abortion and retained fetal bone are the commonly proposed theories. In most of the reported cases, the osseous changes followed a previous history of abortion. The time interval between the antecedent abortion and discovery of the ossification varies from 8 weeks to 14 years. Ultrasound examination plays a primary role in the diagnosis of patients with osseous metaplasia. However, it should be confirmed by hysteroscopic examination.