TERT and neoplasm: Our study, however, does not exclude the existence of context dependent, or transient changes in gene expression caused by these mutations—indeed, the study of Chiba et al. [22] demonstrated that the effects of TERT promoter mutations were most critical during cell differentiation, and it is possible that the mutation clusters identified in this study may similarly only manifest their effects at critical junctures of carcinogenesis thereby increasing the likelihood of survival of the tumor cells.