The discrepancy in the patient with Lynch associated pancreatic cancer may be explained by the isolated loss of MSH6, since it has been shown that isolated loss of MSH6 does not always result in complete loss of mismatch repair function [6], which possibly explains why the tumour did not reach the cut-off of a msIndel burden of 4.0 indels/Mb [31]. Here, MSH6 is linked to neoplasm.