Tumors that are MMRd or MSI-high can originate through three pathways: germline MMR mutations in DNA mismatch repair proteins MLH1, PMS2, MSH2, MSH6, named Lynch syndrome; somatic MMR gene mutations occasionally labelled as Lynch-like; and homozygous methylation of the MLH1 gene promoter named sporadic [38]. The gene discussed is MLH1; the disease is Lynch syndrome.