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RCOG World Congress 2023
June 12 - 14, 2023 | London, UK
EP.0845
'BONE' IN ENDOMETRIUM! - Hysteroscopic management of osseous metaplasia presenting with secondary infertility.
Part of Topic
Endometriosis and Uterine Disorders
Video
‘BONE IN ENDOMETRIUM’: HYSTEROSCOPIC MANAGEMENT OF OSSEOUS ENDOMETRIAL METAPLASIA CAUSING SECONDARY INFERTILITY
INTRODUCTION
•Osseous metaplasia of endometrium is an uncommon disorder of the endometrium commonly associated with secondary infertility.
•It is characterized by metaplasia of endometrial cells into osteoblastic cells and leads to presence of mature or immature bone in the endometrium. It is important to note that this tissue is not related to embryonic or fetal origin and is a true metaplasia of endometrial cells.
AIM
•Osseous endometrial metaplasia is a rare pathological condition frequently associated with infertility.
•Despite multiple theories about its development, the exact mechanism, the source of the osseous tissue and the possible treatment outcomes are not clearly defined. Moreover, it is yet not clear whether surgical removal of the osseous tissue can restore fertility in the patients.
•We present three patients who presented to us with secondary infertility and were diagnosed to have osseous endometrial metaplasia. They were then treated with hysteroscopic removal of the osseous fragments. All three patients had spontaneous conception after the procedure.
CASE DETAILS
•A 32-year-old patient from a rural part of India presented with history of secondary infertility and irregular menstrual bleeding for 1 year.
•On a 3-D Trans-vaginal sonography done post menstrual at our setup, the endometrial cavity appeared hyperechogenic suggestive of calcification with irregular endometrium (Fig. 1).
•On the 7th day post menses, she underwent hysteroscopy under spinal anaesthesia with Bettocchi 4 scope that is a 1.9 mm and 30 degree forward oblique scope with continuous flow suction & irrigation with Normal saline and E.A.S.I. endomat with intrauterine pressure 45mm Hg.
•With vaginoscopic technique the external uterine orifice (EUO) was negotiated and in the cervical canal osseous trabecular material was seen, it was gradually removed with 5 Fr crocodile grasper. The internal uterine orifice (IUO) was occupied by bony fragments which were removed and then the uterine cavity was visualized studded with multiple trabecular osseous material with spicules mimicking a ‘coral reef’ which were gradually removed only with a grasper.
•The histopathological exam confirmed the presence of well formed mature bony trabeculae without any inflammation suggestive of endometrial metaplasia (Figure 3).
•She had spontaneous conception about 12 weeks after the procedure