SMAD4 and Lynch syndrome: There was no evidence of other cancer predisposition variants initially identified in the tumor (MSH6 p.Tyr642*, POLE p.Ala456Pro, SMAD4 p.Arg361His, TP53 p.Ala161Thr, or TP53 p.Arg248Trp), confirming the unusual diagnosis of Lynch syndrome in this patient.