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Table 4. The Revised Bethesda Guidelines for Testing Colorectal Tumors for Microsatellite Instability (MSI) • Colorectal cancer diagnosed in a patient who is less than 50 years of age. Presence of the synchronous or metachronous colorectal cancer or other HNPCC – associated tumors*, regardless of the age. • Colorectal cancer with the MSI-H, histology, diagnosed in a patient who is less than 60 years of age. • Colorectal cancer diagnosed in one or more first-degree relatives with HNPCC related tumor*, with one of the cancer being diagnosed under the age of 50 years. • Colorectal cancer diagnosed in two or more first- or second -degree relatives with HNPCC- related tumors regardless of the age. *colorectal carcinoma, endometrial carcinoma, and other related cancer: small bowel, transitional cell carcinoma of the upper urinary tract, stomach, ovarian, brain( Turcot syndrome) and sebaceous gland adenomas or keratoachantomas ( Muir-Torre sundrome). MSI-H, microsatelite instability-high in tumors refers to changes in equal or more than 2 of the 5 national cancer institute (NCI)-recommended panels. HNPCC, hereditary nonpolyposis colorectal cancer