In 2020, Hackeng et al. proposed that CIN in insulinoma might be associated with underlying ATRX or DAXX mutations, as was shown previously for NF-PanNETs [19, 41]: in a cohort of 35 insulinomas, of which 30 indolent and five aggressive, ALT was observed in four out of five aggressive insulinomas while it was absent in all indolent cases. Here, ATRX is linked to cervical squamous intraepithelial neoplasia.