A man in his early 30s had pancreatic cancer (2.5-cm pancreatic head mass) with multiple hepatic metastases (largest 2.3 cm and 2.4 cm) and multiple peripancreatic lymph nodes at treatment initiation, and his tumor harbored RET–TRIM33 and RET–JMJD1C fusions; other genomic alterations detected on liver biopsy were FGFR4 p.R493Q, which was a variant of unknown significance, and PTCH1 p.1287_1303del and PTEN copy number loss, which were not considered actionable drivers. The gene discussed is PTCH1; the disease is familial pancreatic carcinoma.