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

Anatomopathologic Study of Kidneys parasitized by Dioctophyme renale in Dogs

Background: Dioctophymiasis is a disease caused by the nematode Dioctophyme renale and is a relatively common condition in dogs. The parasite affects the kidney, especially the right, enters the kidney capsule and causes destruction and atrophy of the parenchyma. The lesion severity depends on the amount of parasites affecting the kidney, the duration of the infection, number of kidneys involved and concurrent occurrence of kidney disease. The diseases clinical presentation may be asymptomatic or with nonspecific clinical signs. The diagnosis is based on ultrasound examination and the detection of eggs in urine, however, diagnosis is often reached only through necropsy or histopathology. This study aimed to analyze the dog kidney anatomical and pathological changes when parasitized by Dioctophyme renale.Materials, Methods & Results: The kidneys of 21 dogs diagnosed with dioctophymiasis were nephrectomized, analyzed by ultrasound and forwarded to macro and microscopic analysis. Macroscopically, the kidney size was measured as well as its renal capsule thicknes. The presences of dilatation of the renal pelvis and ureter, as well as changes of the capsule, were also observed. These fragments were collected and submitted for routine analysis and stained with hematoxylin and eosin. Histopathological examination was performed blindly by three evaluators. The intensity of fibrosi

Anatomopathologic Study of Kidneys parasitized by Dioctophyme renale in Dogs

Background: Dioctophymiasis is a disease caused by the nematode Dioctophyme renale and is a relatively common condition in dogs. The parasite affects the kidney, especially the right, enters the kidney capsule and causes destruction and atrophy of the parenchyma. The lesion severity depends on the amount of parasites affecting the kidney, the duration of the infection, number of kidneys involved and concurrent occurrence of kidney disease. The diseases clinical presentation may be asymptomatic or with nonspecific clinical signs. The diagnosis is based on ultrasound examination and the detection of eggs in urine, however, diagnosis is often reached only through necropsy or histopathology. This study aimed to analyze the dog kidney anatomical and pathological changes when parasitized by Dioctophyme renale.Materials, Methods & Results: The kidneys of 21 dogs diagnosed with dioctophymiasis were nephrectomized, analyzed by ultrasound and forwarded to macro and microscopic analysis. Macroscopically, the kidney size was measured as well as its renal capsule thicknes. The presences of dilatation of the renal pelvis and ureter, as well as changes of the capsule, were also observed. These fragments were collected and submitted for routine analysis and stained with hematoxylin and eosin. Histopathological examination was performed blindly by three evaluators. The intensity of fibrosi

Anatomopathologic Study of Kidneys parasitized by Dioctophyme renale in Dogs

Background: Dioctophymiasis is a disease caused by the nematode Dioctophyme renale and is a relatively common condition in dogs. The parasite affects the kidney, especially the right, enters the kidney capsule and causes destruction and atrophy of the parenchyma. The lesion severity depends on the amount of parasites affecting the kidney, the duration of the infection, number of kidneys involved and concurrent occurrence of kidney disease. The diseases clinical presentation may be asymptomatic or with nonspecific clinical signs. The diagnosis is based on ultrasound examination and the detection of eggs in urine, however, diagnosis is often reached only through necropsy or histopathology. This study aimed to analyze the dog kidney anatomical and pathological changes when parasitized by Dioctophyme renale.Materials, Methods & Results: The kidneys of 21 dogs diagnosed with dioctophymiasis were nephrectomized, analyzed by ultrasound and forwarded to macro and microscopic analysis. Macroscopically, the kidney size was measured as well as its renal capsule thicknes. The presences of dilatation of the renal pelvis and ureter, as well as changes of the capsule, were also observed. These fragments were collected and submitted for routine analysis and stained with hematoxylin and eosin. Histopathological examination was performed blindly by three evaluators. The intensity of fibrosi

Anatomopathologic Study of Kidneys parasitized by Dioctophyme renale in Dogs

Background: Dioctophymiasis is a disease caused by the nematode Dioctophyme renale and is a relatively common condition in dogs. The parasite affects the kidney, especially the right, enters the kidney capsule and causes destruction and atrophy of the parenchyma. The lesion severity depends on the amount of parasites affecting the kidney, the duration of the infection, number of kidneys involved and concurrent occurrence of kidney disease. The diseases clinical presentation may be asymptomatic or with nonspecific clinical signs. The diagnosis is based on ultrasound examination and the detection of eggs in urine, however, diagnosis is often reached only through necropsy or histopathology. This study aimed to analyze the dog kidney anatomical and pathological changes when parasitized by Dioctophyme renale.Materials, Methods & Results: The kidneys of 21 dogs diagnosed with dioctophymiasis were nephrectomized, analyzed by ultrasound and forwarded to macro and microscopic analysis. Macroscopically, the kidney size was measured as well as its renal capsule thicknes. The presences of dilatation of the renal pelvis and ureter, as well as changes of the capsule, were also observed. These fragments were collected and submitted for routine analysis and stained with hematoxylin and eosin. Histopathological examination was performed blindly by three evaluators. The intensity of fibrosi

Anatomopathologic Study of Kidneys parasitized by Dioctophyme renale in Dogs

Background: Dioctophymiasis is a disease caused by the nematode Dioctophyme renale and is a relatively common condition in dogs. The parasite affects the kidney, especially the right, enters the kidney capsule and causes destruction and atrophy of the parenchyma. The lesion severity depends on the amount of parasites affecting the kidney, the duration of the infection, number of kidneys involved and concurrent occurrence of kidney disease. The diseases clinical presentation may be asymptomatic or with nonspecific clinical signs. The diagnosis is based on ultrasound examination and the detection of eggs in urine, however, diagnosis is often reached only through necropsy or histopathology. This study aimed to analyze the dog kidney anatomical and pathological changes when parasitized by Dioctophyme renale.Materials, Methods & Results: The kidneys of 21 dogs diagnosed with dioctophymiasis were nephrectomized, analyzed by ultrasound and forwarded to macro and microscopic analysis. Macroscopically, the kidney size was measured as well as its renal capsule thicknes. The presences of dilatation of the renal pelvis and ureter, as well as changes of the capsule, were also observed. These fragments were collected and submitted for routine analysis and stained with hematoxylin and eosin. Histopathological examination was performed blindly by three evaluators. The intensity of fibrosi

Anatomopathologic Study of Kidneys parasitized by Dioctophyme renale in Dogs

Background: Dioctophymiasis is a disease caused by the nematode Dioctophyme renale and is a relatively common condition in dogs. The parasite affects the kidney, especially the right, enters the kidney capsule and causes destruction and atrophy of the parenchyma. The lesion severity depends on the amount of parasites affecting the kidney, the duration of the infection, number of kidneys involved and concurrent occurrence of kidney disease. The diseases clinical presentation may be asymptomatic or with nonspecific clinical signs. The diagnosis is based on ultrasound examination and the detection of eggs in urine, however, diagnosis is often reached only through necropsy or histopathology. This study aimed to analyze the dog kidney anatomical and pathological changes when parasitized by Dioctophyme renale.Materials, Methods & Results: The kidneys of 21 dogs diagnosed with dioctophymiasis were nephrectomized, analyzed by ultrasound and forwarded to macro and microscopic analysis. Macroscopically, the kidney size was measured as well as its renal capsule thicknes. The presences of dilatation of the renal pelvis and ureter, as well as changes of the capsule, were also observed. These fragments were collected and submitted for routine analysis and stained with hematoxylin and eosin. Histopathological examination was performed blindly by three evaluators. The intensity of fibrosi

Adenocarcinoma gástrico com ossificação heterotópica em cão - relato de caso / Gastric adenocarcinoma with heterotopic ossification in a dog - a case report / Adenocarcinoma gástrico con osificación heterotópica en perro - reporte de caso

Este relato descreve e discute os achados clínicos, anatomopatológicos e imuno-histoquímicos de um caso de adenocarcinoma gástrico com ossificação heterotópica em cão macho de doze anos com histórico de vômitos frequentes não responsivos a tratamento. Na necropsia, o estômago na região fúndica e no corpo próximo à curvatura menor apresentava parede intensamente espessada, elevada, irregular e firme. A microscopia demonstrou áreas multifocais de proliferação neoplásica maligna de células epiteliais, formando ácinos ou túbulos contendo quantidade variável de mucina e múltiplos focos de ossificação heterotópica. As células neoplásicas foram positivas para citoqueratina e negativas para vimentina e osteocalcina. Metástases da neoplasia foram observadas nos Iinfonodos gástricos e nos pulmões.(AU)

This report describes and discusses the clinical, pathological and immunohistochemical findings in a case of gastric adenocarcinoma with heterotopic ossification in a 12-year-old male dog with a history of non responsive and frequent vomiting. At necropsy, the stomach fundus and body near the lesser curvature had a markedly thick, raised, irregular and firm wall. Light microscopy showed multifocal areas of malignant neoplastic proliferation of epithelial cells, forming tubules containing acini with variable amount of mucin and multiple foci of heterotopic ossification. The neoplastic cells were positive for cytokeratin and negative for vimentin and osteocalcin. Metastases of gastric cancer were observed in lymph nodes and lungs.(AU)

Este reporte describe y analiza los aspectos clínicos, patológicos e inmunohistoquímicos en un caso de adenocarcinoma gástrico con osificación heterotópica en un perro, macho, de 12 años, con un cuadro de vómitos frecuentes no responsivos al tratamiento. Durante la necropsia el paciente presentaba la pared de la región fúndica y de la curvatura menor muy engrosada, elevada, irregular y firme. La microscopia mostró áreas multifocales de una proliferación neoplásica maligna de células epiteliales, que formaban acinos o túbulos, y que contenían una cantidad variable de mucina y focos múltiples de osificación heterotópica. Las células neoplásicas fueron positivas para citoqueratina y negativas para vimentina y osteocalcina. Se observaron metástasis de la neoplasia en linfonódulos gastricos y en pulmones.(AU)

Adenocarcinoma gástrico com ossificação heterotópica em cão - relato de caso / Gastric adenocarcinoma with heterotopic ossification in a dog - a case report / Adenocarcinoma gástrico con osificación heterotópica en perro - reporte de caso

Este relato descreve e discute os achados clínicos, anatomopatológicos e imuno-histoquímicos de um caso de adenocarcinoma gástrico com ossificação heterotópica em cão macho de doze anos com histórico de vômitos frequentes não responsivos a tratamento. Na necropsia, o estômago na região fúndica e no corpo próximo à curvatura menor apresentava parede intensamente espessada, elevada, irregular e firme. A microscopia demonstrou áreas multifocais de proliferação neoplásica maligna de células epiteliais, formando ácinos ou túbulos contendo quantidade variável de mucina e múltiplos focos de ossificação heterotópica. As células neoplásicas foram positivas para citoqueratina e negativas para vimentina e osteocalcina. Metástases da neoplasia foram observadas nos Iinfonodos gástricos e nos pulmões.

This report describes and discusses the clinical, pathological and immunohistochemical findings in a case of gastric adenocarcinoma with heterotopic ossification in a 12-year-old male dog with a history of non responsive and frequent vomiting. At necropsy, the stomach fundus and body near the lesser curvature had a markedly thick, raised, irregular and firm wall. Light microscopy showed multifocal areas of malignant neoplastic proliferation of epithelial cells, forming tubules containing acini with variable amount of mucin and multiple foci of heterotopic ossification. The neoplastic cells were positive for cytokeratin and negative for vimentin and osteocalcin. Metastases of gastric cancer were observed in lymph nodes and lungs.

Este reporte describe y analiza los aspectos clínicos, patológicos e inmunohistoquímicos en un caso de adenocarcinoma gástrico con osificación heterotópica en un perro, macho, de 12 años, con un cuadro de vómitos frecuentes no responsivos al tratamiento. Durante la necropsia el paciente presentaba la pared de la región fúndica y de la curvatura menor muy engrosada, elevada, irregular y firme. La microscopia mostró áreas multifocales de una proliferación neoplásica maligna de células epiteliales, que formaban acinos o túbulos, y que contenían una cantidad variable de mucina y focos múltiples de osificación heterotópica. Las células neoplásicas fueron positivas para citoqueratina y negativas para vimentina y osteocalcina. Se observaron metástasis de la neoplasia en linfonódulos gastricos y en pulmones.

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.

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.

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.