Lynch syndrome Online training for pathologists M3 IHC interpretation

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1. What is your name? *

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2. The MMR proteins are best considered in 2 pairs due to the way the proteins dimerise. What are these 2 pairs? Please select 2 answers *

MLH1 and PMS2
MLH1 and MSH2
MLH1 and MSH6
MSH2 and MSH6
PMS2 and MSH6

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3. How frequently is abnormal staining observed in colorectal and Endometrial cancers? Please, select 2 answers *

10% Colorectal cancer cases
15% Colorectal cancer cases
25% Colorectal cancer cases
11% Endometrial cancer cases
21% Endometrial cancer cases
31% Endometrial cancer cases

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4. What is the null phenotype? *

Complete loss of all 4 proteins
Clonal loss of MSH2
Clonal loss of MSH2 and MSH6
Clonal loss of PMS2

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5. When you face an unusual case, what are the reassuring features? *

Additional clonal loss of MSH6 +/- MSH2 in sporadic MLH1/PMS2 loss (confirmed BRAF mutation or MLH1 promoter hypermethylation)
Synchronous tumours with different results
Advanced age (though can be misleading)
All of the above

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6. When you face an unusual case, what are the worrying features? *

Complete loss of MSH6 +/- MSH2 in any context (confirm on resection if available)
Synchronous tumours with the same pattern of loss
All of the above
There are no worrying features

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