Chronic renal failure and endometrial osseous metaplasia: a hypothetical pathway

Abstract

Figure 1. Hysteroscopic aspect of osseous metaplasia of the endometrium.

Intriguing case of foreign body in uterine cavity

“…An imbalance between superoxide free radical and superoxide dismutase system has also been implicated in pathogenesis. 9 Other possible causes that have been researched are abnormal calcium, vitamin-D and phosphorus metabolism like hypercalcemia (metastatic calcification), hyperphosphatemia and hypervitaminosis D. 10 In our case, even though history of abortion is not given, a single bony spicule softly embedded or freely attached within the endometrial cavity and presence of endometritis suggest retained fetal products. Lewis et al 11 also documented the presence of inflammation by the increased concentrations of prostaglandins in endometrial osseous metaplasia.…”

Long and fluctuating bone fragments in uterine isthmus: A curious feature of true osseous metaplasia

“…In addition, the hysteroscopic features of osseous metaplasia are generally described as white pieces of bony spicules, frequently arising from the posterior wall and extending into the cavity, with a hard tactile consistency. 3,9 In our case, the macroscopic pattern of the tissue ossification was intriguing: numerous white elongated fragments, floating in the uterine cavity, resembling long spaghetti-like filaments, with the base in the back isthmic wall. The histological findings describe a rare picture of true osseous metaplasia with the extraordinary presence of cells referable to areas of hematopoietic tissue.…”

“…Many theories have been proposed to explain the origin, such as continuous and strong endometrial estrogenic stimulation, dystrophic calcification of retained and necrotic tissues, metastatic calcification, metabolic disorders and hypercalcemia (hypervitaminosis D or hyperphosphatemia). [7][8][9] Direct implantation of retained fetal bones was proposed by some authors, 10 but this might be valid for second-trimester abortions. However, there are also rare case reports of nulliparous patients or of abortion that occurred at a very early gestational age, when no fetal bony tissue had yet been formed.…”

“…7,15 Currently, hysteroscopy is acknowledged as the gold standard for definitive diagnosis and treatment 9 by the complete removal of bone fragments under vision and possible ultrasonic guidance that helps complete removal of the spicules, which may be embedded in the myometrium. 1,9 Histological evaluation is necessary for definite diagnosis. Osseous metaplasia can be distinguished, microscopically, from fetal tissue retention by the absence of surrounding tissue reaction and endochondral ossification.…”

“…3 Physicians should be more informed and alert regarding osseous metaplasia in all its strange shapes and localizations, so as to be able to follow suitable therapy. Furthermore, as uterine bone formation can be seen in malignant mixed Müllerian tumors and in teratomas, 9 it is important for pathologists to recognize the nonneoplastic nature of this condition to avoid making a wrong diagnosis of malignant Müllerian tumor of the uterus.…”