Torné A, Jou P, Pagano R, Sanchez I, Ordi J, Vanrell J A
Department of Obstetrics and Gynaecology, Hospital Clinic i Provincial, University of Barcelona, Spain.
Eur J Obstet Gynecol Reprod Biol. 1996 May;66(1):75-7. doi: 10.1016/0301-2115(95)02376-3.
Endometrial ossification is a rare condition. The common feature in most reported cases is a previous history of abortion and retention of fetal bones. Few cases of endometrial ossification can be explained by osseous metaplasia. Clinical presentation may include abnormal vaginal bleeding or discharge, dysmenorrhoea, pelvic pain, and secondary infertility. Hysterectomy or dilation and curettage have been the usual therapeutic methods used. Recently, some cases have been treated by means of hysteroscopic resection.
We report a case of endometrial ossification in a woman who presented with dysmenorrhoea, dyspareunia and pelvic pain. The patient had a pregnancy voluntarily terminated at 16 weeks. Five subsequent routine annual gynaecological exams, including ultrasonographies, were normal. A new gestation was also voluntarily terminated at 6 weeks. One month later the patient started with clinical manifestations. Ultrasonograms performed 4 months after the second abortion revealed a strong uterine echogenic band. Bone tissue was successfully removed by hysteroscopic resection.
This case adds further evidence favouring new bone formation in the uterus as a pathogenic mechanism for endometrial ossification and illustrates the feasibility of hysteroscopic treatment for this condition.
子宫内膜骨化是一种罕见病症。大多数已报道病例的共同特征是既往有流产及胎儿骨骼残留史。少数子宫内膜骨化病例可由骨化生解释。临床表现可能包括异常阴道出血或分泌物、痛经、盆腔疼痛及继发性不孕。子宫切除术或刮宫术一直是常用的治疗方法。近来，一些病例通过宫腔镜切除术进行治疗。
我们报告一例子宫内膜骨化病例，该女性患者表现为痛经、性交困难及盆腔疼痛。患者曾在孕16周时自愿终止妊娠。随后的五次常规年度妇科检查，包括超声检查，均正常。患者又在孕6周时自愿终止了一次妊娠。一个月后患者开始出现临床表现。第二次流产后4个月进行的超声检查显示子宫内有一条强回声带。通过宫腔镜切除术成功切除了骨组织。
该病例进一步证明子宫内新骨形成是子宫内膜骨化的致病机制，并说明了宫腔镜治疗这种病症的可行性。
