Multiple cutaneous and uterine leiomyomas is an autosomal dominant condition t hat results in benign smooth muscle tumours of the skin and, in females, uterine fibroids. This syndrome overlaps with hereditary leiomyomatosis and renal cell cancer syndrome in which affected individuals may develop the rare type II papil lary renal cell cancer, in addition to skin leiomyomas. Recently, heterozygous m utations in the gene encoding fumarate hydratase have been found to underlie bot h conditions. Fumarate hydratase is an enzyme that catalyses the conversion of f umarate to malate in the Kreb’s cycle and may also function as a tumour suppres sor gene. We report a family with multiple leiomyomas, uterine fibroids and papi llary renal cell cancer. The proband is a 77-year-old Polish woman who develop ed multiple cutaneous leiomyomas on her right upper arm in her thirties and subs equently underwent a hysterectomy for uterine fibroids in her forties. She has f our offspring: her eldest daughter also has skin and uterine leiomyomas with a s imilar onset; her son has multiple skin leiomyomas and in addition was diagnosed with metastatic papillary renal cell cancer at the age of 50 years; the two you ngest daughters are unaffected. DNA sequencing in all the affected individuals d isclosed a heterozygous G ?úC substitution at nucleotide 173 ofthefumaratehydra tasegene,thatconvertsanarginineresidue (CGA) to proline (CCA). This missense mut ation has not been reported previously and is designated R58P. Interestingly, th e clinically asymptomatic 20-year-old son of the individual with renal cancer was also found to be heterozygous for R58P. It is likely that he will develop sk in leiomyomas in the future but the risk of renal cancer is difficult to predict . Nevertheless, detection of this mutation has important implications for screen ing and genetic counselling in this and other family members. Multiple cutaneous and uterine leiomyomas is an autosomal dominant condition t hat results in benign smooth muscle tumors of the skin and, in females, uterine fibroids. This syndrome overlaps with hereditary leiomyomatosis and renal cell cancer syndrome in which affected individuals may develop the rare type II papil lary renal cell cancer, in addition to skin leiomyomas. Recently, heterozygous m utations in the gene encoding fumarate hydratase have been found to underlie bot h conditions. Fumarate hydratase is an enzyme that catalyses the conversion of fumarate to malate in the Kreb’s cycle and probiotic is a 77-year-old Polish woman who develop ed multiple cutaneous leiomyomas on her right upper arm in her thirties and subs equently underwent a hysterectomy for uterine fibroids in her forties. She has f our offspring: her eldest daughter also has skin and uterine leiomyomas with as imilar onset; her son has multiple skin leiomyomas and in addition was diagnosed with metastatic papillary renal cell cancer at the age of 50 years; the two you ngest daughters are unaffected. DNA sequencing in all affected subjects d isclosed a heterozygous G? úC substitution at nucleotide 173 of the fumarate hydra tasegene, thatconvertsanarginineresidue (CGA) to proline (CCA). This missense mutagenesis has not been reported previously and is designated R58P. Interestingly, th e clinically asymptomatic 20-year-old son of the individual with renal cancer was also found to be heterozygous for R58P. It is likely that he will develop sk in leiomyomas in the future but the risk of renal cancer is difficult to predict. Nevertheless, detection of this mutation has important implications for screen ing and genetic counseling in this and other family members.