Endometrium appearance in a patient with caesarean scar diverticulum

A 36-year-old Chinese woman was referred to our Reproductive Medicine Clinic with secondary infertility. She explained that six years ago, cesarean section was performed because of breech presentation smoothly. Her menstrual cycle became irregular with prolonged and postmenstrual spotting lasting between 10 and 15 days four year ago; before this, her periods last 28–30 days with 4–5 days of bleeding. At transvaginal ultrasound examination, a cesarean scar diverticulum of 23×12 mm was identified. Hysteroscopy was done after exclusion of pregnancy, and we found a rare and interesting endometrial manifestation: diffuse short-red earthworm-like appearance on the endometrium of margin of diverticulum (Figure 1A), anterior wall (Figure 1B), bottom of uterine cavity (Figure 1C), and around opening of oviduct (Figure 1D). Endometrial biopsy showed that endometrial glands were dilated, erythrocyte degeneration was accumulated, and CD138 was negative by immunohistochemistry. This phenomenon is related to hematocele in uterine cavity.

Figure 1 Photograph of endometrium appearance under hysteroscopy. (A) The endometrium of margin of diverticulum; (B) anterior wall; (C) bottom of uterine cavity; (D) around opening of oviduct.

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Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/ls.2019.12.04). The authors have no conflicts of interest to declare.

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