title: Unusual DNA mismatch repair-deficient tumors in Lynch syndrome: a report of new cases and review of the literature.
abstract: Immunohistochemical detection of DNA mismatch repair proteins and polymerase chain reaction detection of microsatellite instability have enhanced the recognition of mismatch repair-deficient neoplasms in patients with Lynch syndrome and, consequently, led to the identification of tumors that have not been included in the currently known Lynch syndrome tumor spectrum. Here, we report 4 such unusual tumors. Three of the 4, a peritoneal mesothelioma, a pancreatic acinar cell carcinoma, and a pancreatic well-differentiated neuroendocrine tumor, represented tumor types that, to the best of our knowledge, have not been previously reported in Lynch syndrome. The fourth tumor was an adrenocortical carcinoma, which has rarely been reported previously in Lynch syndrome. Three of our 4 patients carried a pathogenic germ-line mutation in a mismatch repair gene. The unusual tumor in each of the 3 patients showed loss of the mismatch repair protein corresponding to the mutation. The fourth patient did not have mutation information but had a history of colonic and endometrial carcinomas; both lacked MSH2 and MSH6 proteins. Interestingly, none of the 4 unusual tumors revealed microsatellite instability on polymerase chain reaction testing, whereas an appendiceal carcinoma from 1 of the study patients who was tested simultaneously did. The recognition of such tumors expands the repertoire of usable test samples for the workup of high-risk families. As yet, however, there are no data to support the inclusion of these tumors into general screening guidelines for detecting Lynch syndrome, nor are there data to warrant surveillance for these tumors in patients with Lynch syndrome.
authors.affiliation: Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Yevgeniy
authors.initials: Y
authors.lastname: Karamurzin
authors.forename: Zhaoshi
authors.initials: Z
authors.lastname: Zeng
authors.forename: Zsofia K
authors.initials: ZK
authors.lastname: Stadler
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.forename: Ihsane
authors.initials: I
authors.lastname: Ouansafi
authors.forename: Hikmat A
authors.initials: HA
authors.lastname: Al-Ahmadie
authors.forename: Christine
authors.initials: C
authors.lastname: Sempoux
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Saltz
authors.forename: Robert A
authors.initials: RA
authors.lastname: Soslow
authors.forename: Eileen M
authors.initials: EM
authors.lastname: O'Reilly
authors.forename: Philip B
authors.initials: PB
authors.lastname: Paty
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Coit
authors.forename: Jinru
authors.initials: J
authors.lastname: Shia
authors.forename: David S
authors.initials: DS
authors.lastname: Klimstra
mesh_terms: D018268:Adrenocortical Carcinoma / Q000473:pathology; D000328:Adult; D000368:Aged; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000235:genetics* / Q000473:pathology*; D053843:DNA Mismatch Repair / Q000235:genetics*; D005260:Female; D018095:Germ-Line Mutation; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000235:genetics / Q000473:pathology; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000235:genetics / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000235:genetics / Q000473:pathology