ZNRF3 and neoplasm: These studies have identified recurring mutations in several genes such as ZNRF3 (20%), CTNNB1 (14%), TP53 (14%), CDKN2A (11%), RB1 (5%), MEN (16%), DAXX (5%), MED12 (3%) and TERT (5%).[11] Despite the identification of common genetic abnormalities, the development of targeted therapies for this disease has been thwarted by the rarity of ACC as illustrated by the small sample sizes ranging from 8 to 132 tumor samples in these studies characterizing the genomic alterations.