Metaplasia ósea del endometrio. Reporte de un caso y revisión de la bibliografía / Endometrial osseous metaplasia. Case report and literatura review

RESUMEN La metaplasia ósea endometrial es una patología poco común que se asocia a infertilidad secundaria. La mayoría de casos se presenta en mujeres con antecedente de gestación no evolutiva. La sospecha se hace mediante el hallazgo de un endometrio hiperecogénico que se asemeja a la imagen de un dispositivo intrauterino. El gold standard para el diagnóstico y tratamiento es la histeroscopia con el estudio histopatológico del material obtenido en el pre-cedimeinto. La importancia de su descripción es su presentación en una paciente nuligesta. Se describe el caso clínico y revisión de la literatura. Palabras claves: Metaplasia ósea endometrial, infertilidad secundaria, endometrio hiperecogénico

ABSTRACT Endometrial osseoum metaplasia is a rare condition associated with secondary infertility. Most cases occur in women with a histo-ry of non-evolutionary pregnancy. The suspicion is made by the finding of a hyperechoic endometrium that is similar of an intrauterine de-vice. The diagnostic and therapeutic gold standard is made by hysteroscopy with histopathological study of the material obtained in the precedure. The importance of this case is its presentation in a nulliparous patient. The clinical case and literature review are described

In vivo diagnosis of intraocular osseous metaplasia in neovascular age-related macular degeneration

A 75-year-old man presented with deterioration of right eye vision for 6 months. He had no relevant medical history. Fundus examination revealed subretinal fluid, fibrosis, and subretinal hemorrhages. Ocular coherence tomography of the right macula illustrated an underlying subretinal lesion with internal lamellae, resembling trabecular bone elsewhere in the body. Bruch's membrane was clearly intact beneath the lesion, indicating an extrachoroidal location. The lesion appeared highly reflective on B-scan ultrasonography, consistent with ossification. Although initially misdiagnosed as choroidal osteoma, this lesion represents in-vivo intraocular osseous metaplasia at the site of neovascular age-related macular degeneration. The authors believe that similar lesions may have been misdiagnosed as 揳typical� osteoma caused by failure to identify their extrachoroidal location.

Amyloidosis in a Whooper swan (Cygnus cygnus)

Two Whooper swan (Cygnus cygnus) died after suffering from pododermatitis, lethargy, and ataxia; necropsy was performed. Grossly, the liver was swollen and firm. The kidney and spleen were also enlarged and a pale tan color. On histopathologic examination with Congo red staining, amyloidosis was noted in liver, spleen, and kidney. In addition, marked osseous metaplasia was present in the liver. Based on these results, systemic amyloidosis involving liver, spleen, and kidney with osseous metaplasia in the liver was diagnosed. Study results indicate that an inflammatory reaction associated with pododermatitis had a role in the amyloidosis in this particular case.

Postradiation angiosarcoma of bladder with extensive osseous metaplasia.

Angiosarcomas are rare soft tissue neoplasms accounting for <2% of all sarcomas. Rare cases have been reported in other sites like breast, spleen, liver, bone and bladder. This is a case report of an angiosarcoma of the bladder in a 65 year old lady who came with complaints of haematuria. Ultrasonography and computerized tomography revealed a bladder tumour with calcification, which on cystoscopy also showed a calcified mass. The patient had a past history of carcinoma cervix for which she had undergone surgery and radiotherapy, 22 years ago. Biopsy of the bladder mass showed features of a high grade epithelioid sarcoma with extensive osseous metaplasia. On immune stains,the tumour was positive for CD31 and vimentin and negative for cytokeratin, desmin and CD34. Until now, only sixteen cases of angiosarcoma of the bladder have been reported in english literature, of which 6 occurred secondary to radiation. Our case is the first to occur after 22 years of radiotherapy and have extensive osseous metaplasia.

Bone in intestinal polyp-a curious observation.

We report rare phenomena of ossification in benign colon polyp. An adult woman presented with occasional bleeding per rectum for which she was investigated. A polypoid rectal swelling was detected and histolopathology revealed an inflammatory polyp with osteoid formation. The case is presented for its rarity and available literature is reviewed.

Metaplasia ósea en el músculo flexor digital profundo en un Mastín Napolitano / Osseous metaplasia in the deep digital flexor muscle of a Neapolitan Mastiff / Metaplasia óssea no músculo flexor digital profundo num Mastim Napolitano

Resumen Se describe el caso de una metaplasia ósea en un canino, hembra, de raza Mastín Napolitano, con historia de cojera intermitente del miembro anterior izquierdo. En el examen ortopédico se evidenció una claudicación del miembro afectado, molestia a la flexión y extensión pasiva de la articulación del codo izquierdo. A la palpación se detectó una masa de consistencia sólida a nivel medio-distal del codo, en el examen radiológico del miembro afectado se observó una estructura radiodensa medial a la articulación, en la zona de los músculos flexores del miembro anterior izquierdo sin evidencia de adhesión o contacto con huesos. La estructura fue resectada quirúrgicamente y evaluada histológicamente, diagnosticando una alteración en la reparación tisular de tipo metaplasico, con la formación de tejido óseo. Tanto en el postquirúrgico, como en la reevaluación a los 12 meses, la paciente mostró una marcada mejoría en la claudicación. En el presente reporte, se discute el caso clínico de un paciente con metaplasia ósea a nivel de los músculos flexores del miembro anterior, siendo este el primer caso reportado por tal patología a nivel sudamericano y el segundo caso reportado mundialmente en un perro de raza Mastín Napolitano.

Abstract We describe a case of osseous metaplasia in a canine. A female Neapolitan Mastiff with a history of intermittent left forelimb lameness was evaluated. Orthopedic examination revealed the animal was not standing on the affected limb and had signs of pain on passive flexion and extension of the left elbow joint. A solid mass mass medial of the left elbow was detected on palpation. Radiological examination showed a radiopaque structure medial to the joint, at the level of flexor muscles of the left forelimb, without evident adhesion or contact with bone. The mass was surgically removed and histologically examined. The mass was diagnosed as an altered metaplasic regeneration with formation of bone tissue. The patient showed marked improvement of the lameness few days after surgery and at reevaluation 12 months post-surgery. This report describes a case of osseous metaplasia at the level of the forelimb flexor muscles in a canine patient. To the author's knowledge, this is the first case of such pathology reported in South America, and the second case reported worldwide in a purebred Neapolitan Mastiff.

Resumo Descreve-se o caso de uma metaplasia óssea de uma fêmea canina da raça Mastim Napolitana, com historia de dificuldade intermitente para caminhar no membro anterior esquerdo. No exame ortopédico evidenciou-se uma claudicação do membro afetado, moléstia na flexão e extensão passiva da articulação do cotovelo esquerdo. À palpação detectou-se uma protuberância de consistência solida no nível médio-distal do cotovelo, no exame radiológico do membro afetado observou-se uma estrutura radiodensa medial á articulação, na região dos músculos flexores do membro anterior esquerdo não se encontrou evidencia de adesão ou contato com os ossos. A estrutura foi resectada cirurgicamente e avaliada histologicamente, diagnosticando uma alteração na reparação tissular de tipo metaplásico com a formação de tecido ósseo. Tanto no post-cirúrgico, quanto na reavaliação aos 12 meses, a paciente teve uma marcada melhoria na claudicação. No presente reporte, se discute o caso clínico de uma paciente com metaplasia óssea no nível dos músculos flexores do membro anterior, sendo este o primeiro caso reportado por esta patologia em toda América do Sul e o segundo caso do mundo num cachorro da raça Mastim Napolitano.

Calcified left atrial myxoma with osseous metaplasia.

An intracardiac myxoma is the most common tumour of the heart with an estimated incidence of 0.5 per million population per year. Extensive calcification is rare in these tumours.1 We describe a rare case of a large left atrial myxoma, visible on the chest radiograph, with extensive calcification and osseous metaplasia.

A rare case of prostatic malignancy.

A 70-year-old male presented with refractory urinary retention 3 years back. He had undergone a prior trans urethral resection of prostate (TURP) 5 months back elsewhere. A revision TURP was done and the histopathology showed differentiated adenocarcinoma with cartilaginous and osseous metaplasia. Bone scan showed no evidence of metastasis. He underwent bilateral orchidectomy soon after. He presented with urinary retention 14 months later and underwent TURP. Hard prostatic tissue was resected and histopathology reports were same as previous report. Bone scan showed evidence of solitary metastasis in the second rib. MRI and CT scan showed re-growth. He had persisting lower urinary tract symptoms with hematuria. A palliative radiation was given which alleviated the urinary symptoms; patient refused radical cystoprostatectomy and currently is on conservative management.

Metaplasia ósea endometrial: reporte de casos y revisión de la literatura / Osseous metaplasia of the endometrium: case reports and literature review

Objetivo: presentar dos casos y revisar la literatura acerca de la etiología de la enfermedad y los métodos utilizados para su diagnóstico. Casos clínicos: los casos fueron atendidos en el Hospital de San José, Hospital Universitario de referencia de tercer nivel de atención, a donde llegaron remitidas, por infertilidad y dolor pélvico crónico, dos pacientes. Sus ecografías mostraban imágenes hiperecogénicas en endometrio. Se les realizó histeroscopia, encontrando múltiples formaciones óseas flotantes en cavidad endometrial, extraídas con pinza grasper, cuyos cortes histológicos confirmaron el diagnóstico de metaplasia ósea endometrial. La primera mujer quedó en estado de embarazo 8 meses después de la intervención, finalmente tuvo un recién nacido a término sano. La segunda mujer inició dos embarazos que terminaron en abortos tempranos completos. Materiales y métodos: se realizó una búsqueda electrónica en las bases de datos Medline vía PubMed, SciELO y Ovid, en donde se incluyeron artículos publicados en los últimos 15 años. Conclusión: la metaplasia ósea es un problema de diferenciación celular, de las células madre estromales del endometrio secundario, a raíz de una deficiencia de superóxido dismutasa. Esta entidad se sospecha por ecografía transvaginal y se debe diagnosticar y tratar con histeroscopia.

Objective: presenting two cases and reviewing the pertinent literature concerning the methods used in diagnosing the entity and its etiology. Clinical cases: the cases were attended in the third-level San José teaching hospital where they had been referred due to infertility and chronic pelvic pain. Their echographies revealed hyperechogenic images in the endometrium. Hysteroscopy was performed, revealing multiple osseous formations floating within the endometrial cavity; these were extracted with grasper tweezers and their histological sections confirmed a diagnosis of osseous metaplasia of the endometrium. The first woman became pregnant 8 months later, delivering a healthy newborn at full-term; the second woman became pregnant twice but her attempts ended in complete early abortions. Materials and methods: a search was made of MEDLINE databases via PUBMED, SciELO and Ovid, including articles published during the last 15 years. Conclusion: osseous metaplasia is a cause of infertility involving cellular differentiation of secondary endometrial stromal (stem) cells leading to superoxide dismutase deficiency; this is suspected by transvaginal echography (ultrasound) and should be diagnosed and treated with hysteroscopy.

Lipogranuloma with Osseous Metaplasia in the Breast That Developed after "Bu-Hwang" Oriental Medicine Treatment

A lipogranuloma is an inflammatory reactive process associated with exogenous or endogenous lipids, and it's occurrence in the breast has rarely been reported. Osseous metaplasia, which is used to describe bone formation in abnormal locations, can develop from several conditions such as trauma or a tumor. However, few studies have reported benign breast lesions that have been seen as osseous metaplasia. We present a case of a benign calcified breast lesion that developed after a traumatic treatment process called "Bu-Hwang", and it was confirmed as a lipogranuloma with osseous metaplasia. To the best of our knowledge, this is the first reported case of a lipogranuloma with osseous metaplasia in the breast.

Osseous metaplasia and mature bone formation with extramedullary hematopoiesis in follicular adenoma of thyroid gland.

Follicular adenomas of the thyroid may be subjected to degenerative changes like hemorrhagic and cystic changes, fibrosis, and calcification. Mature bone formation is a rare phenomenon, but extramedullary hematopoiesis (EMH) has also been rarely reported in thyroid gland. The combination of mature bone formation and EMH is rarer and has been reported, in a single case report, in a multinodular goitre. We describe a case of follicular adenoma with histologically proven osseous metaplasia and mature bone formation with EMH in a middle- aged woman, which, to our knowledge, is the first case in English language literature.

A Surgical Experience of Cauliflower Ear with Osseous Metaplasia

Acute auricular hematoma is a common problem in wrestlers, boxers and secondary to trauma such as traffic accident. Early intervention can be limited to simple incision and drainage. Delay in treatment may allow the growth of ectopic fibroneocartilage derived from the damaged perichondrium and it can subsequently cause the unsightly cauliflower ear. Few paper deal with histopathologic analysis of removed excess cartilage fragment. Usual findings are cartilagenous tissue surrounded by fibrous tissue with hemosiderin deposits or cicatrix and foci of cartilage formation. But this case shows degenerative cartilage with osseous metaplasia and it has a stony hard consistency and is clinically a rare disease. The ear cartilage were exposed anteriorly and posteriorly. The deformed cartilage and bony tissue were removed and shaved to restore a normal form. The elevated cutaneous flap was sutured and silastic drainage was applied. We described histopathologic finding and surgical treatment of cauliflower ear with osseous metaplasia.

A Case of Endometrial Ossification Treated by Ultrasound-guided Dilatation and Curettage / 대한산부인과학회잡지

The endometrial osseous metaplasia is one of a rare conditions which gynecologist experience clinically. Clinical presentation may include irregular menstration, abnormal uterine bleeding, discharge, dysmenorrhea, pelvic pain, and secondary infertility. However the etiology and treatment about this disease are unclear. Recently, ultrasound-guided management of ectopic bone in uterus was suggested more potentially safer based on reported multi-patients women, a large majority was successfully treated. We have experienced a case of endometrial osseous metaplasia diagnosed and treated by ultrasound-guided dilatation and curettage. Which is presented with a brief review of literatures.

Metaplasia ósea del endometrio como causa de infertilidad / Bone metaplasia of the endometrium as a cause of infertility

Se presentan dos casos de Metaplasia ósea del endometrio en pacientes infértiles que son sometidas a Resección histeroscópica de fragmentos óseos con embarazo posterior.

Two cases of endometrial osseous metaplasia of the endometrium in infertile patients with ressection of bony tissue by histeroscopy, followed by pregnancy.

A Case of Endometrial Osseous Metaplasia / 대한산부인과학회잡지

The endometrial osseous metaplasia is one of a very rare conditions which gynecologists experience clinically. The characteristics of this disease are history of irregular menstruation, recurrent abortion, infertility with histopathologic evidence of chronic inflammation, and bone formation. This is one of heterotopia(the presence of mature tissue in abnormal location) histopathologically and it is important clinically that infertility can be brought about in the reproductive age women, but the etiology and treatment about this disease are unclear. A case of endometrial osseous metaplasia diagnosed by endometrial biopsy is presented with a brief review of the literatures.

A case of endometrial osseous metaplasia of a referred endometria l cancer patient / 대한부인종양콜포스코피학회잡지

Endometrial osseous metaplasia is a rare condition. The etiology and pathogenesis remain controversial. In most cases, the development of this condition is observed to be related to the history of abortion, either spontaneous or therapeutic and also, frequently associated with menstrual irregularity and endometritis. Patients usually present with secondary amenorrhea, irregular menstruation, pain, and dysmenorrhea. The authors recently experienced a case of endometrial osseous metaplasia of a referred endometrial cancer patient who had no history of abortion at all. We report this case with a brief review of the literature.

Pulmonary Alveolar Proteinosis accompanied by Osseous Metaplasia: A case report

The authors experienced a case of pulmonary alveolar proteinosis. A 58-year-old woman presented with 6 months duration of cough sputum and multiple patch mottled densities in both lung fields. Major histologic finding was filling of the alveoli by Periodic-Acid-Schiff-positive proteinaceous material with maintenance of normal alveolar architecture. Osseous metaplasia was seen in the alveolar space, focally. Ultrastructural study revealed numerous lamellar bodies in alveolar spaces. The immunohistochemical study using antibody to surfactant apoprotein revealed positive reaction in proteinaceous material.

A Case of Intradural Spinal Ossifying Schwannoma

The spinal schwannomas are the most common spinal cord tumors and they make some regressive changes such as necrosis, mucous or cystic degeneration, caseation or calcification occasionally. We experienced a case of intradural ossifying schwannoma in 17 years old male, which occurred in the 2nd 3rd thoracic region. On operative finding, it was a very hard, pinkish gray and bean sized mass, and it firmly adhered to the spinal cord. We found dark bluish necrotic changes at the adhered sites of the spinal cord. On microscopical finding it revealed multiple foci of myxoid degeneration and osseous metaplasia with fibromatosis structure in schwannoma.