Endometrial cartilaginous metaplasia: A case report with literature review
A 38-year-old multiparous female, with obstetric score of gravida 4, Para 4, live birth 4, abortion 0, presented with third degree uterovaginal prolapse (recto, cysto, and enterocele) for which she underwent transvaginal hysterectomy. Duration between the last pregnancy and hysterectomy was 7 years. There was no previous history of any intrauterine contraceptive device insertion. Also, there was no history of previous surgical intervention like dilatation and curettage after the last pregnancy or between pregnancies. There was no history of discharge per vagina, fever, or pelvic pain.\nHer menstrual cycles were regular, 5-7 days/30 days. However, a history of passage of clots and dysmennorhoea was present.\nHysterectomy specimen received for histopathological examination revealed the uterus with cervix measuring 8 × 3 × 2 cm. The cut section showed a tiny gray-white smooth, glistening rice grain like lesion measuring approximately 0.6 × 0.2 cm was embedded in the substance of uterus. An intramural fibroid measuring 2 cm in diameter, firm in consistency, showing whorled appearance was noted [Figures and ].\nMicroscopic examination revealed unremarkable squamocolumnar junction of cervix with squamous metaplasia of few cervical glands. Chronic inflammatory infiltrate was noted in cervical stroma.\nA section from the endometrium incidentally showed a solitary focus of well-formed hyaline cartilage in the endometrial stroma. Transition between stromal and cartilaginous cells was evident, which helped us to identify it as metaplastic. The surrounding endometrial tissue showed secretory changes. Inflammatory reaction and necrosis were absent. No evidence of granuloma was observed. Myometrium revealed adenomyotic foci with an intramural fibroid [].\nA histological diagnosis of endometrial cartilaginous metaplasia with adenomyosis and leiomyoma-uterus was made.