TY - JOUR T1 - Additional loss of MSH2 and MSH6 expression in sporadic deficient mismatch repair colorectal cancer due to MLH1 promoter hypermethylation JF - Journal of Clinical Pathology JO - J Clin Pathol SP - 443 LP - 447 DO - 10.1136/jclinpath-2018-205687 VL - 72 IS - 6 AU - Alice Westwood AU - Amy Glover AU - Gordon Hutchins AU - Caroline Young AU - Scarlet Brockmoeller AU - Rachel Robinson AU - Lisa Worrilow AU - Dave Wallace AU - Kate Rankeillor AU - Julian Adlard AU - Philip Quirke AU - Nicholas West Y1 - 2019/06/01 UR - http://jcp.bmj.com/content/72/6/443.abstract N2 - 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. ER -