Endometrial osseous metaplasia: Presentation of two rare cases related with infertility, and their hysteroscopic approaching

  • José Martínez-Más Obstetrics and Gynecology Department. Santa Lucía University Hospital, Cartagena, Murcia, Spain.
  • Paloma Gómez-Leal Obstetrics and Gynecology Department, Santa Lucía University Hospital, Cartagena.
  • Juan Pedro Martínez-Cendán Assistant Professor at Obstetrics and Gynecology Department, Catholic University of Murcia (UCAM), Murcia
  • Andrés Bueno-Crespo Assistant Professor at Computer Science Department, Catholic University of Murcia (UCAM), Murcia
  • Sebastián Ortiz-Reina Pathology Department, Cartagena Hospital Complex, Cartagena
  • Carmen López-Peña Pathology Department, Cartagena Hospital Complex, Cartagena.
  • María Isabel Sánchez-Zapata Obstetrics and Gynecology Department, Santa Lucía University Hospital, Cartagena.
  • Manuel Remezal-Solano Assistant Professor at Obstetrics and Gynecology , Catholic University of Murcia (UCAM), Murcia


Objective: To present two cases of patients diagnosed of endometrial osseous metaplasia related with infertility and their hysteroscopic approaching.

Design: Case report.

Setting: Two clinical cases diagnosed and treated at Institutional University Hospital. Patients: Two premenopasual women diagnosed and treated in our Center.

Interventions: Transvaginal ultrasound scan, diagnostic hysteroscopy and hysteroscopic removal of bone fragments. Main Outcome Measures: Ultrasound scan during further clinical follow up.

Results: Both patients underwent a diagnostic hysteroscopy, and removal of all the bone fragments with total resolution of their pathology.

Conclusions: Endometrial osseous metaplasia is a rare pathology that should be suspected in patients with a history of secondary infertility, several miscarriages and curettages, that present with an ultrasound image compatible with an intrauterine device. Hysteroscopic approach is the best diagnostic and therapeutic option.


Key words: Endometrial osseous metaplasia, bony intrauterine tissue, miscarriage, infertility, hysteroscopy, unadverted intrauterine device.


2. Thaler H. Uberlebendes fotales knorpelgewebe in der uterushohel nach abortus. Zentralbl agynekol 1923;46:1784-7.
3. De Brux J, Palmer R, Anoub-Despois H. Les ossification de l’endometre. Gynecol Obstet 1956;55:494.
4. Patil SB, Narchal S, Paricharak DG, More SS. Endometrial Osseous Metaplasia: Case Report with Literature Review. Annals of Medical and Health Sciences Research, Nov 2013, Vol 3, Sup 1.
5. Bahceci M, Cem L. Osseous metaplasma of the endometrium: a rare case of infertility and its hysteroscopic management. Human Reprod 1996; 11:2537-39.
6. Bedaiwy MA, Goldberg JM, Biscotti CH. Recurrent osseous metaplasia of the cervix after loop electrosurgical excision. Obstet Gynecol 2001;98:968-70.
7. Elford K, Claman P:Novel treatment of a patient with secondary infertility due to retaines fetal bone. Fertil Steril 2003;79:1028-1030.
8. Verstraete JP, Adnet JJ, Wahl P. Osteogenic metaplasia or residual embryonic endometrial ossification?. J. Gynecol Obstet Biol Reprod (Paris) 1984;13:425-31.
9. Torne A, Jou P, Pagano R, Sánchez I, Ordi J, Vanrell JA. Endometrial ossification succesfully treated by hysteroscopic resection. Eur J Obstet Gynecol Reprod Biol 1996;66:75-7.
10. Hsu C. Endometrial ossification. Br J Obstet Gynaecol 1975; 82:836-9.
11. Ejeckam GC, Hasled F, Ahamad R, Azadeh B. Endometrial Ossifiaction. Trop Georg Med 1991;43:314-6.
12. Mannu GS1, Ahmed F1, Cunnick G1, Mungalsingh N2. Bone formation within breast abscess. BMJ Case Rep. 2014 Sep 22;2014.
13. Joshi M, Remoundos DD, Ahmed F, Rees G, Cunnick G. An unusual breast lump: osseous metaplasia. BMJ Case Rep. 2013; Published online 2013 Feb 4.
14. Markert E1, Gruber-Moesenbacher U, Porubsky C, Popper HH. Lung osteoma--a new benign lung lesion. Virchows Arch. 2006 Jul;449(1):117-20.
15. Nogales FF, Gómez Morales M, Raymundo C, Aguilar D. Benign heterologous tissue components associated with endometrial carcinoma. Int J Gynecol Pathol 1982;1:286-91.
16. Lewis V, Khan-Dawood F, King M, Beckham C, Dawood My. Retention of fetal bone increases menstrual prostaglandins. Obstet Gynecol 1990;75:561-3.
17. Marcus S, Bhattacharya J, Williams G, Brinsden P, Hamou J. Endometrial ossification: a case of secondary infertility. Report of two cases. Am J Obstet Gynecol 1994;170:1381-3.
18. Tsai MC, Arunamata A, Tristan S, Randall HW. Endometrial osseous metaplasia mimicking retained intrauterine device. J Reprod Med 2008;53:877-880.
19. Coccia ME, Becattini C, Bracco GL, Scarselli G. Ultrasound-guided hysteroscopic management of endometrial osseous metaplasia. Ultrasound Obstet Gynecol 1996;66:75-7.
20. Pace S, Torcia F, Palazzetti PL, Piazze JJ, Cipriano L, Pachi A. Succesful diagnostic and surgical hysteroscopy for endometrial ossification. Clin Exp Obstet Gynecol 2001;28:24-5.
21. Polat I, Sahin O, Yildirim G, Karaman E, Erim A, Tekirdag AI, Osseous metaplasia of the cervix and endometrium: a case of secondary infertility. Fertility and Sterility, 2011;95,7:2434.e1-e4.
How to Cite
MARTÍNEZ-MÁS, José et al. Endometrial osseous metaplasia: Presentation of two rare cases related with infertility, and their hysteroscopic approaching. International Archives of Medicine, [S.l.], v. 10, aug. 2017. ISSN 1755-7682. Available at: <http://imedicalsociety.org/ojs/index.php/iam/article/view/2726>. Date accessed: 13 nov. 2019. doi: https://doi.org/10.3823/2505.
Obstetrics & Gynecology