This study also indicates that dedifferentiation is likely not driven by BRAF or RAS mutations individually but rather by the combined effort of multiple genetic alterations.[35,38] Vincenzo Marotta et al[21] stated that prognostic effect related to alterations of TERT promoter disappeared or strikingly decreased when mutations occurred separately, suggesting that actual prognostic value of the genetic marker had been overestimated and co-existence of BRAF mutation was mandatory for promoting tumor aggressiveness. This evidence concerns the gene TERT and neoplasm.