Invasive endometrial lesion in a patient with mental retardation.

46-year-old Caucasian woman with mental retardation experienced discomfort and irregular menstrual bleeding, which had been increasing for 2 years. The physician from her group home sent her to a gynecologist, where a mass prolapsing through the cervix was noted on physical examination. Cervical and endometrial biopsies were done. Both showed polypoid fragments of endometrium with complex hyperplasia with cytologic atypia and squamous metaplasia (Figure 1). A computed tomography scan showed the mass in the uterine cavity, but everything else appeared normal. She was referred to a gynecologic oncologist. The patient had three risk factors for endometrial cancer: obesity (she weighed 210 pounds, and her body mass index was 36 kg/m2), nulliparity, and hypertension. Both her hypertension and a seizure disorder were well controlled with medications. It was unclear if Pap smears had been done in the past. The probability of endometrial cancer was discussed with her, and she agreed to surgery. Informed consent was obtained through her brother, her legal guardian who also had medical power of attorney. Procedures included exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymph node dissection. Baylor Sammons Cancer Center at Dallas Site Tumor Conference