Endometrial osseous metaplasia complicated by secondary infertility: a case report

Endometrial osseous metaplasia is a rare condition in which there is abnormal presence of bone in the endometrium. There is paucity of reported cases of this pathological condition in Africa and it is usually overlooked as a cause of infertility. Pathogenesis is not well understood but mostly occurs following pregnancy. Pathology may be suspected on ultrasound scan where a linear echogenic substance is seen in the endometrium but diagnosis is confirmed by and treated with hysteroscopy. We present a case of a 43-year-old woman with 2 previous miscarriages who presented with secondary infertility. She had an ultrasound scan done which revealed features suggestive of an intra-uterine copper device. She subsequently had hysteroscopy and a bone-like foreign body was found in the endometrium which was removed with the aid of a grasper and later sent for histopathological evaluation for which a subsequent diagnosis of endometrial osseous metaplasia was made. Indeed, endometrial intraosseous metaplasia should be considered an important differential cause of secondary infertility especially in patients with history of previous miscarriage. Confirmatory diagnosis can be made through hysteroscopy and/or histopathologically although the former is now used.