By performing signature assignment analysis we attributed 41% of all somatic single nucleotide variants to Signature 18 (Figure 3B), previously associated with inactivation of MUTYH in a series of familial colorectal cancer and adrenocortical carcinomas [49], indicating that the germline variant was driving the pattern of somatic mutations, and underlay development of EC in this individual. This evidence concerns the gene MUTYH and adrenal cortex carcinoma.