{"id":2931,"date":"2024-08-21T15:28:22","date_gmt":"2024-08-21T12:28:22","guid":{"rendered":"https:\/\/marmarapatoloji.com\/?p=2931"},"modified":"2026-05-07T04:01:43","modified_gmt":"2026-05-07T04:01:43","slug":"mikrosatellite-instabilite-msi","status":"publish","type":"post","link":"https:\/\/marmarapatoloji.com\/en\/2024\/08\/21\/mikrosatellite-instabilite-msi\/","title":{"rendered":"Mikrosatellite Instability (MSI)"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">Mikrosatelitler (k\u0131sa tandem tekrarlar\u0131), 2 &#8211; 10 n\u00fckleotidlik tekrarlayan motiflerden olu\u015fan tekrarlayan DNA dizileridir. Uyumsuzluk onar\u0131m\u0131 (MMR) genlerinde ( MLH1, PMS2, MSH2, MSH6\u00a0) kusurlar oldu\u011funda\u00a0, DNA sentezi s\u0131ras\u0131nda mikrosatelit b\u00f6lgelerine giren mutasyonlar onar\u0131lmaz ve bu da mikrosatelit instabilitesine (MSI) neden olur.<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Mikrosatelit instabilitesi (MSI), kolorektal adenokarsinom (CRC) karsinogenezinde rol oynayan yollardan biridir; MSI&#8217;li kolorektal kanser, MSI \/ mikrosatelit karars\u0131z veya MMR eksikli\u011fi (dMMR) olan kolorektal kanser olarak adland\u0131r\u0131l\u0131r. Mikrosatelit instabilitesi (MSI), bir veya daha fazla uyumsuzluk onar\u0131m geninin ( MLH1, PMS2, MSH2, MSH6\u00a0)\u00a0anormal i\u015flevinden kaynaklan\u0131r.<\/p>\n\n\n\n<figure class=\"wp-block-image alignright size-full\"><img fetchpriority=\"high\" decoding=\"async\" width=\"355\" height=\"450\" class=\"wp-image-2948\" src=\"https:\/\/marmarapatoloji.com\/wp-content\/uploads\/2024\/08\/msi-1.jpg\" alt=\"\" srcset=\"https:\/\/marmarapatoloji.com\/wp-content\/uploads\/2024\/08\/msi-1.jpg 355w, https:\/\/marmarapatoloji.com\/wp-content\/uploads\/2024\/08\/msi-1-237x300.jpg 237w\" sizes=\"(max-width: 355px) 100vw, 355px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Kolorektal adenokarsinomlar\u0131n (CRC) %10 &#8211; 15&#8217;i MSI \/ MMR eksikli\u011fine sahiptir (dMMR). dMMR kolorektal kanseri, MLH1\u00a0promot\u00f6r\u00fcn\u00fcn sporadik hipermetilasyonu\u00a0veya MMR genlerindeki germ hatt\u0131 mutasyonlar\u0131 (\u00a0<a href=\"https:\/\/www.pathologyoutlines.com\/topic\/colontumorlynch.html\" target=\"_blank\" rel=\"noreferrer noopener\">Lynch sendromu<\/a>\u00a0) nedeniyle ortaya \u00e7\u0131kar.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patolojide, kolorektal kanser ilk olarak imm\u00fcnohistokimya kullan\u0131larak MMR proteinlerinin varl\u0131\u011f\u0131n\u0131n de\u011ferlendirilmesiyle MSI a\u00e7\u0131s\u0131ndan taran\u0131r. Bir veya daha fazla MMR proteininin kayb\u0131, MLH1\u00a0hipermetilasyon testi veya\u00a0BRAF\u00a0mutasyon testi ile takip edilir ;\u00a0MLH1\u00a0hipermetilasyonunun veya bir\u00a0BRAF\u00a0mutasyonunun yoklu\u011fu,\u00a0Lynch sendromunu de\u011ferlendirmek i\u00e7in germ hatt\u0131 mutasyonunu harekete ge\u00e7irir.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">dMMR kolorektal kanserinin belirlenmesi \u00f6nemlidir \u00e7\u00fcnk\u00fc bu t\u00fcm\u00f6rler mikrosatelit stabil (MSS) t\u00fcm\u00f6rlere k\u0131yasla daha iyi t\u00fcm\u00f6r evresine ve dolay\u0131s\u0131yla da daha iyi sa\u011f kal\u0131ma sahiptir. Lynch sendromu daha \u00f6nce kal\u0131tsal nonpolipozis kolorektal kanser (HNPCC) sendromu olarak biliniyordu.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">MMR ile ili\u015fkili bir gendeki biallelik germ hatt\u0131 mutasyonuna anayasal uyumsuzluk onar\u0131m eksikli\u011fi ad\u0131 verilir.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Kolorektal kanserlerin %10 &#8211; 15&#8217;i dMMR&#8217;dir (\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22302899\/\" target=\"_blank\" rel=\"noreferrer noopener\">Clin Cancer Res 2012;18:1506<\/a>\u00a0)<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>dMMR kolorektal kanserlerinin %80&#8217;i sporadiktir\n<ul class=\"wp-block-list\">\n<li>MLH1\u00a0promot\u00f6r\u00fcn\u00fcn\u00a0hipermetilasyonu<\/li>\n\n\n\n<li>\u2265 60 ya\u015f\u0131nda<\/li>\n\n\n\n<li>F &gt; E<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>dMMR kolorektal kanserinin %20&#8217;si aileseldir\n<ul class=\"wp-block-list\">\n<li>Otozomal dominant, germ hatt\u0131 mutasyonu (Lynch sendromu)<\/li>\n\n\n\n<li>~ 40 &#8211; 50 ya\u015f aras\u0131<\/li>\n\n\n\n<li>E = F<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h5 class=\"wp-block-heading\">dMMR kolorektal kanseri sa\u011f kolona e\u011filimlidir (\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/836152\/\" target=\"_blank\" rel=\"noreferrer noopener\">Arch Surg 1977;112:170<\/a>\u00a0)<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.pathologyoutlines.com\/topic\/colontumortubularadenoma.html\" target=\"_blank\" rel=\"noreferrer noopener\">Lynch sendromu ile ili\u015fkili kolorektal kanser, t\u00fcb\u00fcler adenomlardan<\/a>\u00a0kaynaklan\u0131r\u00a0(\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28548127\/\" target=\"_blank\" rel=\"noreferrer noopener\">Mod Pathol 2017;30:1144\u00a0<\/a>)<\/li>\n\n\n\n<li><a href=\"https:\/\/www.pathologyoutlines.com\/topic\/colontumorsessileserrated.html\" target=\"_blank\" rel=\"noreferrer noopener\">Sporad\u0131k dMMR kolorektal kanseri , sesil t\u0131rt\u0131kl\u0131 adenomlardan\/poliplerden<\/a>\u00a0(SSA\/P)\u00a0kaynaklan\u0131r (\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17204026\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Histopatoloji 2007;50:113<\/a>\u00a0)<\/li>\n<\/ul>\n\n\n\n<h5 class=\"wp-block-heading\">MMR yolu (\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31494725\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">J Gastroenterol 2020;55:15\u00a0<\/a>)<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>DNA replikasyonu s\u0131ras\u0131nda yap\u0131lan DNA baz ikamesi uyumsuzlu\u011funu (mismatch), eklemeleri (insersiyon), silmeleri (delesyon) veya kaymalar\u0131 (slippage) d\u00fczeltir<\/li>\n\n\n\n<li>Hatalar iki protein kompleksinin etkisiyle d\u00fczeltilir:\n<ul class=\"wp-block-list\">\n<li>MutS\u03b1: mutS homolog 2 (MSH2) ve mutS homolog 6 (MSH6) proteinlerinin heterodimeri<\/li>\n\n\n\n<li>MutS\u03b2: MSH2 ve mutS homolog 3 (MSH3) proteinlerinin heterodimeri<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>MutS\u03b1 veya MutS\u03b2, kusurlu b\u00f6lgeye ba\u011flan\u0131r ve MutL\u03b1&#8217;y\u0131 (mutL homologu 1 [MLH1] ve postmeiotik segregasyon art\u0131\u015f\u0131 2 [PMS2] proteinlerinin heterodimeri) devreye sokar.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img decoding=\"async\" width=\"450\" height=\"448\" class=\"wp-image-2950\" src=\"https:\/\/marmarapatoloji.com\/wp-content\/uploads\/2024\/08\/msi-2.jpg\" alt=\"\" srcset=\"https:\/\/marmarapatoloji.com\/wp-content\/uploads\/2024\/08\/msi-2.jpg 450w, https:\/\/marmarapatoloji.com\/wp-content\/uploads\/2024\/08\/msi-2-300x300.jpg 300w, https:\/\/marmarapatoloji.com\/wp-content\/uploads\/2024\/08\/msi-2-150x150.jpg 150w\" sizes=\"(max-width: 450px) 100vw, 450px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">&nbsp;<\/p>\n\n\n\n<h5 class=\"wp-block-heading\">Kolorektal kanser MSS\/MMR yeterli (pMMR) veya MSI\/MMR eksik (dMMR)<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>pMMR kolorektal kanseri: sa\u011flam MMR genleri<\/li>\n\n\n\n<li>dMMR kolorektal kanseri: Bir veya daha fazla MMR genini etkileyen anormallik\n<ul class=\"wp-block-list\">\n<li>Sporad\u0131k\n<ul class=\"wp-block-list\">\n<li>MLH1\u00a0promot\u00f6r hipermetilasyonu<\/li>\n\n\n\n<li>%50\u00a0BRAF\u00a0V600E mutasyonu<\/li>\n\n\n\n<li>ARID1A&#8217;n\u0131n\u00a0karsinogenezde bir rol\u00fc olabilir (\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25311944\/\" target=\"_blank\" rel=\"noreferrer noopener\">Hum Pathol 2014;45:2430\u00a0<\/a>)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Ailevi &#8211; Lynch sendromu\n<ul class=\"wp-block-list\">\n<li>Ola\u011fan tip alelde somatik mutasyonu izleyen germ hatt\u0131 mutasyonu<\/li>\n\n\n\n<li>MLH1, PMS2, MSH2, MSH6, EPCAM&#8217;daki (\u00a0MSH2&#8217;ye\u00a0biti\u015fik\u00a0)\u00a0mutasyonlar<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Di\u011fer:\n<ul class=\"wp-block-list\">\n<li>\u0130zole PMS2 kayb\u0131 olan nadir vakalar\n<ul class=\"wp-block-list\">\n<li>Hastalar daha ileri ya\u015fta gelirler ve di\u011fer b\u00f6lgelerde karsinom riski daha d\u00fc\u015f\u00fckt\u00fcr (\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25512458\/\" target=\"_blank\" rel=\"noreferrer noopener\">J Clin Oncol 2015;33:319<\/a>\u00a0)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Germ hatt\u0131 mutasyonlar\u0131 ve MLH1\u00a0hipermetilasyonu\u00a0olmayan dMMR t\u00fcm\u00f6rleri\n<ul class=\"wp-block-list\">\n<li>%70: MMR geninde \u00e7ift somatik mutasyon (\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25111426\/\" target=\"_blank\" rel=\"noreferrer noopener\">J \u200b\u200bPathol 2014;234:548\u00a0,\u00a0Gastroenterology 2014;147:1308<\/a>\u00a0)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h5 class=\"wp-block-heading\">Lynch sendromunda de\u011fi\u015fik organlarda karsinom riskinin artmas\u0131yla ili\u015fkilidir.<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Gastrointestinal: kolon, ince ba\u011f\u0131rsak, mide, hepatobiliyer, pankreas<\/li>\n\n\n\n<li>Genito\u00fcriner: b\u00f6brek, mesane, prostat<\/li>\n\n\n\n<li>Jinekolojik: Endometrium, yumurtal\u0131k<\/li>\n<\/ul>\n\n\n\n<h5 class=\"wp-block-heading\">Klinik de\u011ferlendirme<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>dMMR kolorektal kanserli hastalar asemptomatik olabilir ve g\u00f6zetim kolonoskopisi s\u0131ras\u0131nda tesad\u00fcfen ke\u015ffedilen bir kitleye sahip olabilirken, di\u011ferleri MSS kolorektal kanseri belirtileri (anemi, yorgunluk, kilo kayb\u0131, ba\u011f\u0131rsak al\u0131\u015fkanl\u0131klar\u0131nda de\u011fi\u015fiklik veya hematokezi) g\u00f6sterebilir ve bu da kolonoskopiye yol a\u00e7abilir.<\/li>\n\n\n\n<li>Lynch sendromuna dair klinik \u015f\u00fcphe varsa, Amsterdam Kriterleri veya Bethesda Sistemi kullan\u0131larak tarama yap\u0131labilir:\n<ul class=\"wp-block-list\">\n<li>Amsterdam kriterleri (<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/2022152\/\" target=\"_blank\" rel=\"noreferrer noopener\">\u00a0Dis Colon Rectum 1991;34:424\u00a0<\/a>)\n<ul class=\"wp-block-list\">\n<li>En az 3 akrabada kolorektal kanser olmas\u0131 (1&#8217;i di\u011fer 2&#8217;sinin birinci derece akrabas\u0131)<\/li>\n\n\n\n<li>En az 2 ard\u0131\u015f\u0131k nesil s\u00f6z konusu<\/li>\n\n\n\n<li>En az 1 kolorektal kanser te\u015fhisi konmu\u015f ki\u015fi &lt; 50 ya\u015f\u0131nda<\/li>\n\n\n\n<li><a href=\"https:\/\/www.pathologyoutlines.com\/topic\/colontumorFAP.html\" target=\"_blank\" rel=\"noreferrer noopener\">Ailevi adenomat\u00f6z polipozis (FAP)\u00a0<\/a>hari\u00e7 tutulmu\u015ftur<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Bethesda sistemi (g\u00f6zden ge\u00e7irilmi\u015f) (\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/9392616\/\" target=\"_blank\" rel=\"noreferrer noopener\">J Natl Cancer Inst 1997;89:1758\u00a0<\/a>)\n<ul class=\"wp-block-list\">\n<li>Kolorektal kanser tan\u0131s\u0131 &lt; 50 ya\u015f<\/li>\n\n\n\n<li>Di\u011fer kolorektal kanser veya di\u011fer Lynch sendromuyla ili\u015fkili t\u00fcm\u00f6rlerin varl\u0131\u011f\u0131<\/li>\n\n\n\n<li>MSI-H fenotipi olan kolorektal kanser &lt; 60 ya\u015f\u0131nda te\u015fhis edildi (MSI-H ve MSI-L, Molek\u00fcler \/ sitogenetik b\u00f6l\u00fcm\u00fcnde tart\u0131\u015f\u0131ld\u0131)<\/li>\n\n\n\n<li>Lynch sendromu ile ili\u015fkili t\u00fcm\u00f6re sahip 2+ birinci veya ikinci derece akrabas\u0131 olan kolorektal kanserli hasta<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h5 class=\"wp-block-heading\">Patolojik de\u011ferlendirme (<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/#colontumormolecularmicrosatellitediag\" target=\"_blank\" rel=\"noreferrer noopener\">bkz.\u00a0diyagram 3<\/a>\u00a0)<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>\u00c7o\u011fu kurum, t\u00fcm kolorektal kanser vakalar\u0131n\u0131 MMR eksikli\u011fi a\u00e7\u0131s\u0131ndan test eder\n<ul class=\"wp-block-list\">\n<li>\u0130mm\u00fcnohistokimya (IHC): MLH1, PMS2, MSH2, MSH6 i\u00e7in IHC belirte\u00e7leri\n<ul class=\"wp-block-list\">\n<li>Bir veya daha fazla belirtecin kayb\u0131 ek test yap\u0131lmas\u0131n\u0131 gerektirir\n<ul class=\"wp-block-list\">\n<li>BRAF\u00a0mutasyon durumu (IHC veya PCR)<\/li>\n\n\n\n<li>MLH1\u00a0metilasyon durumu<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Metilasyonun veya\u00a0BRAF\u00a0mutasyonunun yoklu\u011fu germ hatt\u0131 testini te\u015fvik eder\n<ul class=\"wp-block-list\">\n<li>Yeni nesil dizileme<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Belirli boyanma \u015fekilleri;\n<ul class=\"wp-block-list\">\n<li>MLH1 \/ PMS2 kayb\u0131: sporadik lehine<\/li>\n\n\n\n<li>MSH2 \/ MSH6 kayb\u0131: ailevi lehine<\/li>\n\n\n\n<li>\u0130zole PMS2 kayb\u0131: ailevi lehine<\/li>\n\n\n\n<li>\u0130zole MSH6 kayb\u0131: ailevi lehine<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h5 class=\"wp-block-heading\">dMMR kolorektal kanser<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>MSS t\u00fcm\u00f6rlerine k\u0131yasla evreye g\u00f6re ayarlanm\u0131\u015f sa\u011f kal\u0131m oran\u0131 daha iyidir (\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/11535541\/\" target=\"_blank\" rel=\"noreferrer noopener\">Kanser Epidemiol Biyobelirte\u00e7leri \u00d6nceki 2001;10:917<\/a>\u00a0)<\/li>\n\n\n\n<li>Lynch sendromu ve MLH1\u00a0promoter hipermetilasyonu ile ili\u015fkili kolorektal kanser i\u00e7in prognoz\u00a0ayn\u0131d\u0131r (\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26866578\/\" target=\"_blank\" rel=\"noreferrer noopener\">Genet Med 2016;18:863\u00a0<\/a>)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Mikrosatelit instabilite (karars\u0131zl\u0131\u011f\u0131) analizi<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">\u00d6rnek patoloji raporu<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>MSI imm\u00fcnhistokimyas\u0131,\u00a0BRAF\u00a0mutasyonu veya hipermetilasyon durumu i\u00e7in yorumlar kolorektal adenokarsinom patoloji raporuna dahil edilmelidir. \u00d6rnekler \u015funlard\u0131r:\n<ul class=\"wp-block-list\">\n<li>MSI (IHC taraf\u0131ndan) yorumu:\n<ul class=\"wp-block-list\">\n<li>pMMR kolorektal kanser:\n<ul class=\"wp-block-list\">\n<li>Uyumsuzluk onar\u0131m proteinleri MLH1, MSH2, MSH6 ve PMS2 i\u00e7in imm\u00fcnohistokimyasal boyalar uyguland\u0131. T\u00fcm\u00f6r h\u00fccreleri, t\u00fcm\u00f6r\u00fcn MMR a\u00e7\u0131s\u0131ndan yeterli (pMMR) ve muhtemelen mikrosatellit a\u00e7\u0131s\u0131ndan stabil oldu\u011funu g\u00f6steren d\u00f6rt proteinin t\u00fcm\u00fc i\u00e7in n\u00fckleer boyanmay\u0131 korudu.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>dMMR kolorektal kanser:\n<ul class=\"wp-block-list\">\n<li>\u0130mm\u00fcnohistokimyasal boyalar, t\u00fcm\u00f6r\u00fcn MLH1 ve PMS2 ekspresyonunun kayb\u0131 ile uyumsuz onar\u0131m proteini eksikli\u011fi (dMMR) oldu\u011funu, MSH2 ve MSH6&#8217;n\u0131n n\u00fckleer ekspresyonunun ise korundu\u011funu g\u00f6stermektedir. Bunun sporadik tipte bir karsinomu temsil edip etmedi\u011fini belirlemek i\u00e7in\u00a0BRAF\u00a0mutasyon analizi (veya metilasyon durumu) yap\u0131lmaktad\u0131r.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>BRAF\u00a0mutasyonunun yorumlanmas\u0131:\n<ul class=\"wp-block-list\">\n<li>Mutasyonun yoklu\u011fu:\n<ul class=\"wp-block-list\">\n<li>BRAF\u00a0mutasyon analizi yap\u0131ld\u0131 ve V600E mutasyonu tan\u0131mlanmad\u0131. Bunlar t\u00fcm\u00f6r fenotipini de\u011ferlendirmek i\u00e7in yap\u0131lan somatik testlerdir. dMMR t\u00fcm\u00f6rleri sporadik olabilir veya Lynch sendromu \/ kal\u0131tsal polipozis olmayan kolorektal kanserle ili\u015fkili olabilir. Kal\u0131tsal kanser tarama program\u0131na sevk edilmesi \u00f6nerilir.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Mutasyon varl\u0131\u011f\u0131:\n<ul class=\"wp-block-list\">\n<li>Molek\u00fcler testler, MLH1\u00a0promot\u00f6r\u00fcn\u00fcn sporadik hipermetilasyonuyla ili\u015fkili olan\u00a0BRAF\u00a0V600E mutasyonunun varl\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir . Ancak, g\u00fc\u00e7l\u00fc bir aile \u00f6yk\u00fcs\u00fc varsa,\u00a0BRAF\u00a0V600E mutasyonlar\u0131 temelinde hastalar\u0131 germ hatt\u0131 taramas\u0131ndan hari\u00e7 tutarken dikkatli olunmal\u0131d\u0131r\u00a0.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"1024\" height=\"777\" class=\"wp-image-2953\" src=\"https:\/\/marmarapatoloji.com\/wp-content\/uploads\/2024\/08\/msi-3-1024x777.jpg\" alt=\"\" srcset=\"https:\/\/marmarapatoloji.com\/wp-content\/uploads\/2024\/08\/msi-3-1024x777.jpg 1024w, https:\/\/marmarapatoloji.com\/wp-content\/uploads\/2024\/08\/msi-3-300x228.jpg 300w, https:\/\/marmarapatoloji.com\/wp-content\/uploads\/2024\/08\/msi-3-768x582.jpg 768w, https:\/\/marmarapatoloji.com\/wp-content\/uploads\/2024\/08\/msi-3.jpg 1200w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Mikrosatelit hotels (short tandem repeats), 2 \u2013 10 nukleotidlik are a recurrent motif that consists of repetitive DNA sequences. Mismatch repair (MMR) genes ( MLH1, PMS2, MSH2, MSH6 ) that defects in DNA synthesis , and mutations in this region are not repaired during mikrosatelit mikrosatelit instability (MSI) causes.<\/p>","protected":false},"author":1,"featured_media":2956,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-2931","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Mikrosatellite Instabilite (MSI) - Marmara Patoloji<\/title>\n<meta name=\"description\" content=\"Mikrosatelitler (k\u0131sa tandem tekrarlar\u0131), 2 - 10 n\u00fckleotidlik tekrarlayan motiflerden olu\u015fan tekrarlayan DNA dizileridir.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/marmarapatoloji.com\/en\/2024\/08\/21\/mikrosatellite-instabilite-msi\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Mikrosatellite Instabilite (MSI) - 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