Given the inherent heterogeneity of neuroendocrine tumors, it is unclear whether this variability is also reflected in multiple primaries, particularly in key diagnostic parameters, such as tumor grade and neuroendocrine markers, and therapeutic targets like somatostatin receptor 2 (SSTR2) expression, and how these findings influence current diagnostic approaches for multiple RNETs. Here, SSTR2 is linked to neuroendocrine neoplasm.