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Detecting Lynch syndrome in pancreatic ductal adenocarcinoma FNA cytology based on cancer history and immunocytochemistry
  1. Valentyna Kryklyva1,
  2. Claudio Luchini2,
  3. Martijn W J Stommel3,
  4. Iris D Nagtegaal1,
  5. Lodewijk A A Brosens4
  1. 1 Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
  2. 2 Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
  3. 3 Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
  4. 4 Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
  1. Correspondence to Dr Lodewijk A A Brosens, Department of Pathology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; l.a.a.brosens{at}

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We have read with interest recent articles1–3 about microsatellite instability (MSI) in pancreatic ductal adenocarcinoma (PDAC). Although MSI is rare in PDAC, occurring in only 1%–2% of patients, it is of key importance to recognise in view of a likely better prognosis and responsiveness to immunotherapy.4 In addition, identifying MSI in a tumour may represent the initial step in the recognition of a hereditary form of cancer (Lynch syndrome (LS)), facilitating family screening and surveillance.5 Considering the rarity of MSI in PDAC, the question is how to select patients for MSI testing. Previously, it has been advised to routinely examine specific histological PDAC subtypes (ie, mucinous/colloid and medullary type) for MSI status. With this letter, we underscore the importance of cancer history as another indicator for MSI testing in PDAC.

A 76-year-old patient was diagnosed with PDAC by fine needle aspiration(FNA) cytology (figure 1A). A history of cervical cancer at the age of 48 years was mentioned in the medical record, but the …

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  • Contributors LAAB conceived the manuscript. LAAB and VK drafted the manuscript. MWJS is the treating physician and obtained informed consent. CL and IDN revised the manuscript for important intellectual content. All authors revised and approved the final version of the manuscript.

  • Funding This study was supported by a grant from the Dutch Cancer Society (KWF) 2016 10289.

  • Competing interests CL has been a paid expert-consultant on microsatellite instability for BioScience Communications (New York, New York, USA). LAAB served as a paid consultant for Bristol-Myers Squibb in Pathologist Advisory Board PD-L1 CPS testing in upper GI.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.