Compared to all distant organ metastases, a higher frequency of mutations in lymph node metastases were noted in TP53 (72.3% vs 59.4%), ATM (5.4% vs 3%), ATRX (5.3% vs 1.3%), BRCA1 (2.1% vs 0.8%) and other genes such as PALB2, FANCC, FANCE, POLE, IDH2 and PTTPN11. Only mutations in GNAS gene were more commonly found in distant organ metastases compared to lymph node metastases (1.9% vs 8.3%). This evidence concerns the gene GNAS and metastatic malignant neoplasm in the lymph nodes.