VHL and cancer: Patient 5, a 42-year-old female with a medical history of systemic discoid lupus erythematosus, rheumatoid arthritis, and chronic sciatic pain due to spinal synovial cysts treated with foraminotomies, laminectomies, and discectomy at L3-4 and at L4-5, presented with 2 heterozygous pathogenic variants (Multi-Cancer Panel, Invitae Genetics): (1) a substitution in VHL (c.598C>T, p.R200W) and (2) a splice site pathogenic variant in BLM (c.2192+1_2193+9del).