1. MLH1 c.1852_1853delinsGC (aka c.1852_1853AA>GC, Lys618Ala)  Leeds – found in 4 out of ~400 patients  DMuDB – entered Birmingham (x6), Leeds (x1), Dundee (x4) – unclassified  Newcastle consider it non-pathogenic  ~50 entries in InSIGHT (LOVD) database  ~40 entries in New Foundland MMR database  Described at least once in literature (and once in correspondence with IF) in trans with a truncating mutation in non-Turcot/mismatch repair cancer syndrome associated with bi-allelic loss  Some evidence that Lys618Ala reduces MLH1/PMS2 dimerisation by a large degree (Guerrette et al 1999, PMID 10037723)  Yeast functional studies (various methods; DME, 2-hybrid) maintain MMR, sometimes at a sub-normal level (Takahashi at al 2007, Kondo et al 2003, PMIDs 17510385 & 12810663)  Large population study found it at a higher % in healthy individuals than in CRC (familial & sporadic; Christensen et al 2008 PMID1847406)  Consensus? INCLUDE CMGS POLICY IN BP GUIDELINES?

2. Duplications; how do we report them?  Patient: Ca uterus & melanoma. FH uterine, bladder & colon Ca.  Patient & affected sister (Ca uterus) duplication of MSH2 ex1-6 by MLPA (confirmed by 2 nd kit); no further muts in MLH1, MSH2, MSH6.  Endometrial carcinoma – MSI-H & loss of MSH2 & MSH6 on IHC (poor staining for MSH6 on normal control tissue).  Possible production of functional transcriptional element?

3. Duplications; how do we report them?  Triplication/homozygous duplication  Patient: Ca bowel @ 30, Amsterdam +ve on maternal side, no known FH on paternal side (father died glioblastoma @ 60).  4 copies of MLH1 ex5-8 detected – apparently at least 2 of which are contiguous (ascertained by using exon 8F and exon 5R primers & long PCR); possibility of 3 contiguous copies on one allele  Not apparently MMRCS/Turcot syndrome-type clinical picture, despite early onset of CRC.  Found nothing similar in literature – any ideas/shared experience?  Should/will there be something in the BPG regarding MMRCS?