No abnormalities were detected in the four major driver genes of pancreatic cancer (KRAS, TP53, CDKN2A, SMAD4). However, MSI-H and high tumor mutational burden (TMB-H) were identified in both tumor tissue (31 Mut/Mb) and plasma (19 Mut/Mb) (Tables 1A, B). The gene discussed is SMAD4; the disease is neoplasm.