SMAD4 and breast ductal adenocarcinoma: We compared the gene mutations in the present case with those in the COSMIC database (Supplementary Table 3); however, the present case did not show any of the common mutations observed in neuroendocrine tumors (MEN1, ATRX, and DAXX), solid pseudopapillary neoplasms (CTNNB1 and KDM6A), ductal carcinomas (KRAS, TP53, SMAD4, and CDKN2A), acinar cell carcinomas (SMAD4, TP53, and CTNNB1), or PB (CTNNB1).