Malignant Transformation of Omental Endometriosis Presenting With Neurological Manifestations

Background: Adenosarcoma of endometriosis presenting with neurological paraneoplastic manifestations is rare. Case: 30 year old multiparous woman presented to neurologist with stroke. Subsequent evaluation revealed haemorrhagic ascites with adnexal masses and pulmonary thrombosis. Her CA 125 level was very high and ascetic fluid cytology showed adenocarcinoma deposits and she was treated as advanced ovarian malignancy. The plan was to give neoadjuvant chemotherapy and do interval debulking after treating pulmonary thrombosis with anticoagulants. She developed haemorrhagic ascites and pleural effusion and desaturation while on anticoagulants immediately after first cycle of chemotherapy and was managed for the same. Laparotomy after stabilisation revealed large multiple friable tumor masses in the peritoneal cavity, Omentum and rectovaginal septum. Uterus and adnexa appeared normal. Evacuation of freely floating tumor masses, resection of rectovaginal and omental masses and TAH with BSO with infracolic omentectomy was carried out. Histopathological examination showed transition of benign endometriotic elements and malignant stromal component with sarcomatous changes in tumor masses fulfilling the Sampson’s and Scott’s criteria for malignant transformation of extrauterine endometriosis. Chemotherapy was restarted (paclitaxel and carboplatin) after surgery and was given for 3 cycles. But she developed recurrence in pelvic lymphnodes and parametrium after 3 cycles. She was later treated with Ifosphamide for which she reponded with disappearence of recurrence. Literature search did not reveal a similar case presentation and this may be the first case of adenosarcoma of omental endometriosis presenting with neurological manifestations.