MSH3-related adenomatous polyposis in a patient with the negative family history of colorectal polyps

Recently, biallelic MSH3 germline pathogenic/likely pathogenic variants have been recognized as a rare cause of adenomatous polyposis. We present a 49-year-old woman who was admitted to our high-risk colorectal cancer clinic after incidental detection of a biallelic MSH3 (likely) pathogenic variant when tested for the germline (likely) pathogenic variants in hereditary breast and ovarian cancer related genes. The focus of this case report is to describe the genotype and phenotype of our patient with MSH3-related adenomatous polyposis. More than half of the polyps (13/19) were located in the right colon. In addition, benign and malignant extraintestinal lesions may be common as our patient had simple liver and kidney cysts and two basal cell skin carcinomas.

Red blood cell transfusion and skeletal muscle tissue oxygenation in anaemic haematologic outpatients

Background

Stored red blood cells (RBCs) accumulate biochemical and biophysical changes, known as storage lesion. The aim of this study was to re-challenge current data that anaemia in chronically anaemic haematology patients is not associated with low skeletal muscle tissue oxygen (StO₂), and that RBC storage age does not influence the tissue response after ischaemic provocation, using near-infrared spectroscopy.

Patients and methods

Twenty-four chronic anaemic haematology patients were included. Thenar skeletal muscle StO₂ was measured at rest (basal StO₂), with vascular occlusion testing (upslope StO₂, maximum StO₂) before and after transfusion.

Results

Basal StO₂ was low (53% ± 7%). Average RBC storage time was 10.5 ± 3.9 days. Effects of RBC transfusions were as follows: basal StO₂ and upslope StO₂ did not change significantly; maximum StO₂ increased compared to baseline (64 ± 14% vs. 59 ± 10%, p = 0.049). Change of basal StO₂, upslope StO₂ and maximum StO₂ was negatively related to age of RBCs. The decrease of maximum StO₂ was predicted (sensitivity 70%, specificity 100%), after receiving RBCs ≥ 10days old.

Discussion

Resting skeletal muscle StO₂ in chronic anaemic patients is low. RBC storage time affects skeletal muscle StO₂ in the resting period and after ischaemic provocation.