Bone in the Womb: A Case Report of Endometrial Osseous Metaplasia

Osseous metaplasia in the endometrium is a rare pathological condition characterised by the presence of mature bone, potentially leading to menorrhagia and infertility. The probable pathogenesis of this condition is metaplastic alterations in the endometrial stromal cells, leading to the formation of bony spicules. The gold standard for diagnosis of the condition remains histopathological examination, aided by radiological findings. This was a case report of a single case with evidence-based discussions. Informed consent was obtained. We present a case of a 26-year-old female with a previous lower segment caesarean section (LSCS) five years ago and an abortion, followed by dilation and curettage three years ago, presented with heavy menstrual bleeding. Trans-vaginal ultrasound revealed bright, highly echogenic and linear echo-reflective shadows in the endometrial cavity. The complete removal of bony spicules from the endometrium was done by hysteroscopy under sonographic guidance. On histology, a diagnosis of osseous metaplasia of the endometrium was given. The accuracy of the diagnosis is pivotal; it signifies a reversible factor contributing to infertility. Therefore, an accurate identification not only aids in appropriate treatment but also offers substantial relief and hope for those experiencing fertility challenges due to this condition.