Cover Image

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.


Full Text:



Silverberg SG, Tabbara SO. The uterine corpus. Principles and practices of surgical pathology and cytopathology. 3rd ed. USA: Churchill livingstone; pp. 2470-72.

Waxman M, Moussouris HF. Endometrial ossification following an abortion. Am J Obstet Gynecol. 1978; 130:587- 8.

Acharya U, Pinion SB, Parkin DE, Hamilton MP. Osseous metaplasia of the endometrium treated by hysteroscopic resection. Br J Obstet Gynaecol. 1993; 100:391-2.

Bahceci M, Demirel LC. Osseous metaplasia opf the endometrium: a rare cause of infertility and its hysteroscopic management. Hum Reprod. 1996; 11:2537- 9.

Dutt S. Endometrial ossification associated with secondary infertility. Br J Obstet Gynaecol. 1978; 85:787- 9.

Bhatia NN, Hoshiko MG. Uterine osseous metaplasia. Obstet Gynecol. 1982; 60:256- 9.

Shimizu M, Nakayama M. Endometrial ossification in a post menopausal woman. J Clin Pathol. 1997; 50:171- 2.

Cayuela E, Perez-Medina T, Vilanova J, Alejo M, Canadas P. True osseous metaplasia of the endometrium: the bone is not from a fetus. (e1-4). Fertil Steril. 2009; 91(1293):1.

Coccia ME, Becattini C, Bracco GL, Scarselli G. Ultrasound guided hysteroscopic management of endometrial osseous metaplasia. Ultrasound Obstet Gynecol. 1996; 8: 134- 6.

Van den Bosch T, Dubin M, Cornelis A: Favourable pregnancy outcome in a woman with osseous metaplasia of the uterus. Ultrasound Obstet Gynecol. 2000, 15; 445-447.


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

An Initiative of The Tamil Nadu Dr MGR Medical University