Additional loss of MSH2 and MSH6 expression in sporadic deficient mismatch repair colorectal cancer due to MLH1 promoter hypermethylation.
Alice WestwoodAmy GloverGordon HutchinsCaroline YoungScarlet F BrockmoellerRachel RobinsonLisa WorrilowDave WallaceKate RankeillorJulian AdlardPhilip QuirkeNicholas P WestPublished in: Journal of clinical pathology (2019)
Colorectal cancer (CRC) is common with 3% of cases associated with germline mutations in the mismatch repair pathway characteristic of Lynch syndrome (LS). The UK National Institute for Health and Care Excellence recommends screening for LS in all patients newly diagnosed with CRC, irrespective of age. The Yorkshire Cancer Research Bowel Cancer Improvement Programme includes a regional LS screening service for all new diagnoses of CRC. In the first 829 cases screened, 80 cases showed deficient mismatch repair (dMMR) including four cases showing areas with loss of expression of all four mismatch repair proteins by immunohistochemistry. The cases demonstrated diffuse MLH1 loss associated with BRAF mutations and MLH1 promoter hypermethylation in keeping with sporadic dMMR, with presumed additional double hit mutations in MSH2+/-MSH6 rather than underlying LS. Recognition and accurate interpretation of this unusual phenotype is important to prevent unnecessary referrals to clinical genetics and associated patient anxiety.
Keyphrases
- newly diagnosed
- healthcare
- poor prognosis
- dna methylation
- papillary thyroid
- mental health
- transcription factor
- end stage renal disease
- gene expression
- quality improvement
- public health
- case report
- palliative care
- late onset
- high resolution
- risk assessment
- randomized controlled trial
- ejection fraction
- long non coding rna
- squamous cell carcinoma
- low grade
- depressive symptoms
- clinical trial
- amyotrophic lateral sclerosis
- dna damage
- binding protein
- oxidative stress
- patient reported
- health information
- health insurance
- lymph node metastasis