Nevertheless, cases with aggressive clinicopathologic features, such as lymph node metastasis, advanced American Joint Committee on Cancer stage, and tumor recurrence, revealed some gene alterations of PRSS1, MLH1, MUTYH, and KMT5A. These gene alterations may help to classify the high risk group among patients diagnosed with secretory carcinoma. The gene discussed is KMT5A; the disease is metastatic malignant neoplasm in the lymph nodes.