Defective repair of DNA when heterozygous leads to Lynch syndrome (LS) which is inherited in an autosomal dominant fashion. When homozygous, defective repair of DNA leads to constitutional mismatch repair deficiency syndrome (CMMRD), inherited in an autosomal recessive fashion with a predisposition to develop a pattern of childhood malignancies including hematological and solid cancers. We report such a case of a 21-year-old male who developed anaplastic astrocytoma, Burkitt lymphoma, osteochondroma, and colon cancer successively. Each cancer was treated successfully except for colon cancer which developed liver metastasis after the initial treatment with curative intent. However, the patient has been treated for liver metastasis with curative intent and is currently on follow-up. This case report highlights the importance of maintaining a low threshold for investigating CMMRD and other potential cancer predisposition syndromes when a patient presents with multiple cancers in the early years of their life.

To share our experience of presentations and management of  metastatic carcinoma prostate and its complications in tertiary care hospital in underdeveloped country.Methods:This is retrospective study conducted  in institute of kidney diseases Peshawar from January 2017 to December 2020 .Patients were sampled through non probability randomized method mode of presentation ,diagnosis and management of metastatic  carcinoma prostate complications  were evaluated and analyzed .Results:There were 80 patients in the study ,63 patients opted for medical castration while in  17 patients   bilateral orchidectomies done for androgen blockade . Docetoxil  added long with ADT for androgen blockade in 12 patients who were labeled castrate resistant  .12 patients present with urinary retention and channel TURP performed on them and 2 patients have hematuria due to mets in urinary bladder and 4 patients have skeletal metastasis and were managed in respective department. Conclusion:This study concludes that in under developed countries like Pakistan mostly patients of carcinoma prostate  present in metastatic stage with multiple complications and most of  complications can be managed in urology department in close collaboration with other specialized units.

To share our experience of presentations and management of  metastatic carcinoma prostate and its complications in tertiary care hospital in underdeveloped country.Methods:This is retrospective study conducted  in institute of kidney diseases Peshawar from January 2017 to December 2020 .Patients were sampled through non probability randomized method mode of presentation ,diagnosis and management of metastatic  carcinoma prostate complications  were evaluated and analyzed .Results:There were 80 patients in the study ,63 patients opted for medical castration while in  17 patients   bilateral orchidectomies done for androgen blockade . Docetoxil  added long with ADT for androgen blockade in 12 patients who were labeled castrate resistant  .12 patients present with urinary retention and channel TURP performed on them and 2 patients have hematuria due to mets in urinary bladder and 4 patients have skeletal metastasis and were managed in respective department. Conclusion:This study concludes that in under developed countries like Pakistan mostly patients of carcinoma prostate  present in metastatic stage with multiple complications and most of  complications can be managed in urology department in close collaboration with other specialized units.