ATRX and neoplasm: Interestingly, while it is has been previously shown that a larger primary tumour is associated with metastatic risk and TERT/ATRX mutations11, only patients with TERT altered tumours in our series had significantly larger primaries when contrasting to patients without TERT/ATRX alterations (two-sided students t-test, p < 0.05)(Fig. 6D).