According to the 2019 World Health Organization (WHO) recommendations, pNETs are classified as grade 1 (G1), grade 2 (G2), grade 3 (G3) and pancreatic neuroendocrine carcinomas (pNECs) based on the Ki-67 proliferation index and the mitotic activity [3]. This evidence concerns the gene MKI67 and pancreatic endocrine carcinoma.