Case notes
A 19 year old woman was evaluated for recurrent vaginitis and vaginal discharge. Her history included a spontaneous abortion at 8 weeks of pregnancy and infection with human immunodeficiency virus (HIV). A colposcopic examination disclosed a condyloma and a wide white area ( Figure 1 ) . During a subsequent biopsy, the cervix was hard to the touch.
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Radical excision of the hard area was performed. On gross examination, the specimen, which measured 2 cm × 1 cm × 1 cm, revealed a finger-like proliferation overlying a hard lesion ( Figure 2 ) . Microscopic examination demonstrated mature bone tissue of metaplastic origin. The superficial part of the sample showed epithelial hyperplasia and exophytic papillary growth of the squamous epithelium with prominent koilocytic atypia and nuclear changes, features pathognomonic for human papillomavirus infection. Laboratory analysis excluded metabolic disorders.
Conclusions
The diagnosis, based on these observations, was condyloma acuminatum on metaplastic bone tissue ( Figures 3 and 4 ) . Heterotopia is the presence of mature tissue in an abnormal location. Heterotopic bone in the uterine cervix is a very rare finding. Overall, osseous metaplasia occurs in approximately 0.3 per 1000 women. Although numerous cases of endometrial osseous metaplasia appear in the literature, only 5 cases of osseous metaplasia of the cervical epithelium have been reported since 1982 ( Table ). We offer the sixth account of a woman with the disorder.
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