This patient (Table 2, case 19) had a MSH2 and MSH6-deficient colorectal carcinoma but had negative germline MSH2, MSH6, and EPCAM mutation studies fulfilling criteria for “Lynch-like” syndrome. The patient had two solitary MSH2-deficient intestinal crypts, one of which is depicted (black arrow), that suggest Lynch syndrome despite the negative germline mutation studies (MSH2 immunohistochemistry, 100x magnification).