However, cases with aggressive clinicopathologic features have some recurrent gene alterations in PRSS1, MLH1, MUTYH, and KMT5A. Regarding their distinct clinical and histological features, including relatively frequent rates of lymph node metastasis and tumor recurrence, these novel genetic alterations may provide insight into the biological pathogenesis of secretory carcinoma. This evidence concerns the gene MLH1 and neoplasm.