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Journal of Molecular Histology & Medical Physiology

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The Histologic Elements in Endometrial Ossification in a Developing Community

Wilson IBO*

Department of Pathology, Medical Foundation and Clinic, Nigeria

*Corresponding Author:
Wilson IBO
Department of Pathology, Medical Foundation and Clinic, Nigeria
Tel: 2348037208680
E-mail: [email protected]

Received Date: October 10, 2016; Accepted Date: October 14, 2016; Published Date: October 30, 2016

Citation: Wilson IBO (2016) The Histologic Elements in Endometrial Ossification in a Developing Community. J Mol Histol Med Physiol 1: 110

Copyright: © 2016 Wilson IBO. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Case reports of women presenting with symptoms due to underlying endometrial ossification were traced to countries as diverse as Hong Kong, USA, The Netherlands, Spain, India, Tunisia, and Cote d’Ivoire. Therefore, it seems worthwhile to compare such data with the 19 cases gathered over the years personally in a developing community comprising of a large Ethnic Group, the Ibos. Furthermore, following the example of a Birmingham (UK) group, this was achieved by establishing a histopathology data pool, observing that it is suitable for epidemiological analysis. On the macroscopic side, the findings included patient who was able to handle the bone nestling on her cervix. On the microscopic side, it was the formation of fatty marrow in bone itself. In all possibility, previous infected abortion(s) constituted the precursors of the ossifications.

Keywords

Histology; Endometrium; Ossification; Ibos; Nigeri

Introduction

The rare lesion called ossification of the endometrium has elicited case reports from countries as diverse as Hong Kong, USA, The Netherlands, China, India, Tunisia, and Cote d’ Ivoire [1-8]. Accordingly, it is deemed to be useful to present a series from the large Ethnic Group called the Ibos who are domiciled in the South-eastern part of Nigeria. Moreover, on account of the plea of a Birmingham (UK) group that a histopathology data pool facilitates epidemiologic analysis, I have followed suit by utilizing the opportunity of being the pioneer pathologist of the Reference Pathology Laboratory sited in the Capital, Enugu, by The Government of Eastern Nigeria. The period in question is from 1970 to 2000 [9,10] (Table 1).

S/No Lab No Initial Age Parity Town Doctor
1 B 772/76 ON 20 1 Onitsha Emekekwue
2 UH 1138/89 EM 31 5 Enugu Iloabachie
3 UH 1987/87 EE 25 0 Enugu Ilabor
4 UH 1925/88 EA 25 0 Enugu Emelife
5 2116/89 DJ 42 4 Enugu Egwuatu
6 3003/89 EB 32 6 Onitsha Emekekwue
7 1242/90 OJ 35 3 Enugu Udogu
8 UH 1773/90 ON 25 0 Aba Feyi-Waboso
9 UH 1788/90 UF 34 0 Enugu Uche
10 UH 3232/90 EM 27 2 Enugu Okaro
11 R  58/91 EJ 32 2 Afikpo Anozie
12 S  17/91 OG 19 0 Enugu Ezenyiroha
13 920632 IG 27 0 Enugu Okezie
14 920772 OF 32 3 Enugu Iloabachie
15 92093 UC 22 0 Enugu Nnachetam
16 940547 UA 27 0 Enugu Igwegbe
17 9706/28 AF 21 0 Afikpo Ikpeazu
18 970774 OU 31 0 Afikpo Twomey
19 980567 ID 30 4 Gboko Okezie

Table 1: Epidemiologic data in endometrial ossification.

Case Series

Some epidemiologic parameters demand tabulation hereunder, while the Figure indicates microscopic appearances (Figure 1).

molecular-histology-medical-physiology-ossification

Figure 1: Microphotograph showing ossification with background inflammatory infiltrates.

Discussion

I consider some hidden parameters to be worthy of attention. For instance, the US case report mentioned that ossification did not only occur in the endometrium but also in the cervix [2]. Case 15 exhibited this combination. Similarly, this particular Case and also Cases 17 and 19 exhibited not only the bone itself but also fatty marrow.

Incidentally, 12 patients were curetted in Cosmopolitan Enugu. This is understandable. Similar treatment done for another 3 patients at Afikpo is also meaningful. The treatment took place in a Missionary Hospital in this case. This exemplifies the active role of missionary doctors in the health services of developing communities. The question remains, what were the case series in terms of age? As regards to this tabulation, it is clear that the 21-30 age groups preponderated (Table 2). Furthermore, this held true in the literature series as well.

Age(yrs) Series Number Cited Number
<20 2 -
21 – 30 9 5
31 – 40 7 2
41+ 1 1
Total 19 8

Table 2: Comparison of age groups of personal and cited series.

I am convinced that the 10 patients who were still to undergo successful pregnancy constitute pointers to a basic molecular histology truth, namely, prior infected abortion(s), might have already occurred.

In fact, confidential questioning often revealed prior abortion(s) as indicated by their individual physicians. The estimated frequency of such incident is as follows: once in 2 cases; twice in 2 cases; thrice in one case; 4 times in one case; and up to 5 times in one individual. Undoubtedly, this suspicion is in line with the Chinese patient in whom four pregnancy terminations took place! Indeed, in keeping with this concept, it is relevant that Waxman and Moussouris “had an opportunity to examine a patient in whom endometrial bone formation was discovered exactly eight weeks following an induced abortion” [4,11].

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