ATRX and pancreatic insulinoma: 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.