The molecular changes that accompany IPMN-associated dysplasia share some common traits to the pathway described in pancreatic intraepithelial neoplasia (PanIN), but, IPMN-associated dysplasia can also be driven by mutations outside the big four, including mutations in GNAS, RNF43, and numerous others176. The gene discussed is RNF43; the disease is pancreatic intraductal papillary-mucinous neoplasm.