Abstract
We welcome the correspondence from Dr. Seruca and Dr. Sobrinho-Simões confirming our observation of a paucity of microsatellite instability in young patients with gastric adenocarcinoma.1 We recently studied gastric adenocarcinomas in 17 more young patients younger than 40 years from Braga, Portugal (unpublished data). A mutator phenotype suggestive of the hereditary nonpolyposis colorectal carcinoma syndrome2 was found in only one case (6%). However, low level microsatellite instability occurring in less than 29% of markers analyzed3 was detected in 6 more cases (35%). Although the significance of low frequency microsatellite instability is as yet undetermined, there may be subtle differences in the molecular pathology of gastric carcinoma occurring in young patients from relatively high and low risk populations that require exploration. The data reported so far suggest that the prevalence of a hereditary nonpolyposis colorectal carcinoma-associated mutator phenotype is lower in early onset gastric carcinoma than in early onset colorectal carcinoma.4 It remains to be determined whether or not the few early onset gastric carcinomas with a mutator phenotype harbor underlying DNA mismatch repair gene mutations. Jeremy D. Hayden B.Sc. M.B. Ch.B.*, Iain G. Martin M.D. F.R.C.S.*
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