Sequencing of the G3 liver metastasis demonstrated mutations in ATRX and MEN1 and deep deletions in CDKN2A/2B, TP53, and RB1. Sequencing of a G2 periaortic lymph node metastasis from 11 years prior to high-grade progression demonstrated identical variants in ATRX and MEN1, but no alterations in TP53 or RB1. Neither sample was hypermutated. Here, ATRX is linked to metastatic malignant neoplasm in the lymph nodes.