The 2010 guidelines changed to include distinct groups including (i) grade 3 neuroendocrine carcinoma which encompassed both LCNEC and small cell neuroendocrine carcinoma (SCNEC), (ii) and all tumors with Ki-67 greater than 20 and mitotic index greater than 20 (27). The gene discussed is MKI67; the disease is large cell neuroendocrine carcinoma.