The Bare Bones of Endometrial Osseous Metaplasia

Abstract

<h3>Study Objective</h3> To describe the background, pathogenesis, and clinical symptomatology of endometrial osseous metaplasia (EOM). To outline the work-up and management of patients with suspected EOM. To highlight key considerations in managing patients with EOM. <h3>Design</h3> A Case Report. <h3>Setting</h3> Tertiary Care Academic Centre. <h3>Patients or Participants</h3> Case report of a patient with endometrial osseous metaplasia. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> In this video, we present the case of a healthy 39-year-old with a known history of endometriosis who presented with menstrual irregularities and chronic pelvic pain with suprapubic cramping. An advanced transvaginal ultrasound demonstrated echogenic linearities predominantly within the uterine cavity with some extension into the myometrium. Previous uterine instrumentation history includes two early pregnancies treated by D&C as well as two prior IUDs that were documented to have been removed. Endometrial biopsy revealed sampling of normal endometrial tissue without comment of any abnormalities in the tissue obtained. Operative hysteroscopy was performed with findings of osseous trabecular tissue embedded within the myometrium. <h3>Conclusion</h3> This uncommon pathologic entity is important to recognize as a potential cause for chronic pelvic pain, menstrual irregularities and fertility issues. Appropriate detection with ultrasound first-line can help to increase suspicion of this phenomenon. Ultimate investigation via hysteroscopic removal of abnormal tissue with sampling of the underlying endomyometrium is necessary for diagnosis and treatment of symptoms.