Imaging Diagnosis
Findings revealed a dense linear echogenic band in the endometrial cavity
with posterior acoustic shadowing. Myometrium and both ovaries were normal.
Impression
Endometrial ossification (osseous
metaplasia of endometrial tissue)
Discussion
Osteoid metaplasia of the
uterus is a rare disease that affects the uterus and was reported after
abortion, in chronic endometrites, metabolic disorders, and electro excision
of the cervix (e.g. for severe cervical dysplasia).
Heterotopic tissue in the uterus is rare and unexplainable. It is supposed
that remaining fetal bone tissue initiates the procces of osseous metaplasia.
The effects of the heterotopic bone can be compared to those of an IUD
so that symptoms such as irregular bleeding, sterility or infertility,
repeated early abortions are frequently found in these patients; the symptoms
cease only after removal of the bony material from the uterus. After removal
of the bony material the patient can develop a normal pregnancy.
It needs to be differentiated from calcification of a necrotic tissue.
Some authors consider that it is due to retention of placental fragments
or chronic endometritis.
Metabolic disorders like hypercalcemia, hypervitaminosis can also lead
to endometrium calcification. Pathogenetic mechanism is not known, but
cases have been reported especially after abortion. The period of time
between abortion and diagnoses of the disease can vary from several months
to 12 years.
Endometrial ossification in postmenopausal women is very rare. Therefore,
clinicians should consider the possibility of endometrial ossification
as a differential diagnosis of intrauterine foreign body on ultrasound,
even in older patients. In addition, pathologists should be aware of this
rare entity in order to avoid a misdiagnosis of malignant mixed mullerina
tumor in the endometrial curettage specimen, which may result in unnecessary
hysterectomy.
Reference:
http://www.tmj.ro/dump_articol.html?id_numar=4&id_articol=108
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