LS often presents with lymphocyte infiltration, tumor cell dedifferentiation, and adenomas, while sporadic MSI-H CRC are characterized by increased cytoplasmic eosinophils, large vacuolated nuclei, mucin secretion, poor differentiation, high heterogeneity, Crohn’s-like reactions, and a higher prevalence of serrated and sawtooth-like polyps [74, 75].And the LS patients typically exhibit more pronounced local T-cell infiltration and even higher mutational burden compared to sporadic dMMR/MSI-H CRC, leading to a better prognosis [76, 77]. This evidence concerns the gene MUC5AC and Leigh syndrome.