PTEN and Cowden disease: PTEN pathogenic variants are rare, occurring in approximately 1 in 200,000 individuals, and are linked to PTEN Hamartoma Tumor Syndrome (PHTS), which includes Cowden syndrome, Bannayan-Riley-Ruvalcaba syndrome, and Proteus/Proteus-like syndrome.20 This case highlight the importance of multigene panel testing for hereditary breast and ovarian cancer (HBOC) syndrome and its implications for at-risk family members, who can benefit from cascade testing to inform decision-making and take action to reduce their risk of developing cancer.28