ATRX and neoplasm: Although it is believed to be a late event in PanNETs progression and usually occurring in larger tumours, Hackeng et al found that a subset of <2 cm PanNETs (10%) already presents with DAXX and ATRX loss and ALT activation.6 PanNETs <2 cm with ALT activation and DAXX/ATRX loss have a significant shorter disease-free survival, suggesting that DAXX/ATRX status can provide an important biomarker for the management of localised small PanNETs.6