S7). In all but three of these cases, we detected potentially deleterious germline variants in at least one DNA repair gene known to participate in the maintenance of chromosomal stability (CHEK1, FANCL, ATM, RAD51B, RAD50; Fig. 7; Supplementary Table S3). LUAD4 exhibited a distinct focal rearrangement pattern that diverged between primary and metastasis, also associated with germline variants in ATR and FANCA (Fig. 7). In the primary tumor, a prominent chromothriptic pattern was seen in chromosome 8, whereas a distinct event was seen in chromosome 1 in both metastases (Fig. 7). The gene discussed is ATR; the disease is neoplasm.