NOTCH signaling has been shown to have both oncogenic and tumor suppressor properties in cancer.39–41 In solid tumors, inhibition of NOTCH-2 has been associated with an increase in cellular invasion, driven by elevated MMP activity and enhanced secretion of IL-6 and IL-1β.40,42 However, the role of MMP9 in modulating NOTCH activity in VS is not well explored. This evidence concerns the gene IL1B and neoplasm.