Retained fetal bones: An unusual cause of granulomatous reaction on papanicolaou smear

Abstract

Granulomas are a rare finding on Papanicolaou (Pap) smear which if encountered are usually attributed to tuberculosis, especially in an endemic country like India. Here, we report an interesting case of a 40-year-old female presenting with blood-stained discharge and chronic pelvic pain for 8 years. She was advised Pap smear which showed granulomatous inflammation suggestive of tuberculosis. The patient was worked up for tuberculosis which was noncontributory. Dilatation and curettage was done which revealed multiple small bones and bony chips in the endometrial cavity. Following the removal of bones, the patient showed considerable symptomatic improvement. Repeat Pap smear did not reveal any evidence of granuloma. Even after extensive search of literature, we did not come across any such case report in which intrauterine retention of fetal bones evoked a granulomatous response in cervical smears though the presence of uterine granulomas in response to foreign body has been well documented.

Hysteroscopic Removal of Intrauterine-retained Suture Material Causing Pelvic Inflammatory Disease

“…reported the hysteroscopic removal of fetal bone fragments of a patient with a history of a 12-week pregnancy termination 10 years ago, who had complaints of chronic pelvic pain and bloody vaginal discharge for 8 years. [ 7 ] Other case studies also have similar characteristics. Xia et al .…”