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Nora Sahnane Section of Anatomic Pathology, CRIBI Biotechnology Center, Department of Molecular Medicine, Department of Pathology, Department of Surgical and Morphological Sciences, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy

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Daniela Furlan Section of Anatomic Pathology, CRIBI Biotechnology Center, Department of Molecular Medicine, Department of Pathology, Department of Surgical and Morphological Sciences, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy

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Matilde Monti Section of Anatomic Pathology, CRIBI Biotechnology Center, Department of Molecular Medicine, Department of Pathology, Department of Surgical and Morphological Sciences, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy

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Chiara Romualdi Section of Anatomic Pathology, CRIBI Biotechnology Center, Department of Molecular Medicine, Department of Pathology, Department of Surgical and Morphological Sciences, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy

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Alessandro Vanoli Section of Anatomic Pathology, CRIBI Biotechnology Center, Department of Molecular Medicine, Department of Pathology, Department of Surgical and Morphological Sciences, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy

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Emanuela Vicari Section of Anatomic Pathology, CRIBI Biotechnology Center, Department of Molecular Medicine, Department of Pathology, Department of Surgical and Morphological Sciences, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy

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Enrico Solcia Section of Anatomic Pathology, CRIBI Biotechnology Center, Department of Molecular Medicine, Department of Pathology, Department of Surgical and Morphological Sciences, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy

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Carlo Capella Section of Anatomic Pathology, CRIBI Biotechnology Center, Department of Molecular Medicine, Department of Pathology, Department of Surgical and Morphological Sciences, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy

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Fausto Sessa Section of Anatomic Pathology, CRIBI Biotechnology Center, Department of Molecular Medicine, Department of Pathology, Department of Surgical and Morphological Sciences, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy

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Stefano La Rosa Section of Anatomic Pathology, CRIBI Biotechnology Center, Department of Molecular Medicine, Department of Pathology, Department of Surgical and Morphological Sciences, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy

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Introduction High-grade (or poorly differentiated) gastroenteropancreatic (GEP) neuroendocrine carcinomas (NECs) are aggressive cancers with a high propensity for distant metastases. Like the more frequent pulmonary counterparts, they have

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A Karpathakis University College London Cancer Institute, Neuroendocrine Tumour Unit, 72 Huntley Street, London WC1E 6BT, UK
University College London Cancer Institute, Neuroendocrine Tumour Unit, 72 Huntley Street, London WC1E 6BT, UK

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H Dibra University College London Cancer Institute, Neuroendocrine Tumour Unit, 72 Huntley Street, London WC1E 6BT, UK

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C Thirlwell University College London Cancer Institute, Neuroendocrine Tumour Unit, 72 Huntley Street, London WC1E 6BT, UK
University College London Cancer Institute, Neuroendocrine Tumour Unit, 72 Huntley Street, London WC1E 6BT, UK

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, insulinoma, VIPoma and glucagonoma as well as non-functional NETs. Overall 5-year survival for pNET is 80% for all stages and 25% for metastatic disease; median survival is only 10 months for high-grade/poorly differentiated tumours. Improvements in

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Louis de Mestier Université de Paris, Department of Gastroenterology-Pancreatology, Beaujon University Hospital (APHP), Clichy, France

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Angela Lamarca Division of Cancer Sciences, Department of Medical Oncology, The Christie NHS Foundation, University of Manchester, Manchester, United Kingdom

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Jorge Hernando Department of Medical Oncology, Vall d’Hebron University Hospital and Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain

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Wouter Zandee Department of Internal Medicine, Sector Endocrinology, Erasmus University Medical Center and Erasmus MC Cancer Institute, Rotterdam, The Netherlands
Division of Endocrinology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

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Teresa Alonso-Gordoa Department of Medical Oncology, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain

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Marine Perrier Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France

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Annemiek ME Walenkamp Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

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Bipasha Chakrabarty Department of Pathology, The Christie, Manchester, United Kingdom

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Stefania Landolfi Department of Pathology, Vall d’Hebron University Hospital, Barcelona, Spain

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Marie-Louise F Van Velthuysen Department of Pathology, Erasmus University Medical Center and Erasmus MC Cancer Institute, Rotterdam, The Netherlands

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Gursah Kats-Ugurlu Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

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Alejandra Caminoa Department of Pathology, University Hospital Ramon y Cajal, Madrid, Spain

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Maxime Ronot Université de Paris, Department of Radiology, Beaujon University Hospital (APHP), Clichy, France

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Prakash Manoharan Department of Radiology and Nuclear Medicine, The Christie, Manchester, United Kingdom

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Alejandro Garcia-Alvarez Department of Medical Oncology, Vall d’Hebron University Hospital and Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain

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Tessa Brabander Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands

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María Isabel García Gómez-Muriel Department of Radiology, University Hospital Ramon y Cajal, Madrid, Spain

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Guillaume Cadiot Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France

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Anne Couvelard Université de Paris, Department of Pathology, Beaujon/Bichat University Hospital (APHP), Clichy/Paris, France

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Jaume Capdevila Department of Medical Oncology, Vall d’Hebron University Hospital and Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain

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Marianne E Pavel Department of Endocrinology, Erlangen University Hospital, Erlangen, Germany

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Jérôme Cros Université de Paris, Department of Pathology, Beaujon/Bichat University Hospital (APHP), Clichy/Paris, France

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KT Frankel WL Balci S , et al . 2015 The high-grade (WHO G3) pancreatic neuroendocrine tumor category is morphologically and biologically heterogenous and includes both well differentiated and poorly differentiated neoplasms . American

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Segolene Hescot Department of Nuclear Medicine, Institut Curie, Saint-Cloud, France

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Abir Al Ghuzlan Department of Pathology, Gustave Roussy and Paris Saclay University, Villejuif, France

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Theophraste Henry Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay University, Villejuif, France

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Hala Sheikh-Alard Department of Pathology, Gustave Roussy and Paris Saclay University, Villejuif, France

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Livia Lamartina Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay University, Villejuif, France

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Isabelle Borget Department of Biostatistics, Gustave Roussy and Paris Saclay University, Villejuif, France

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Julien Hadoux Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay University, Villejuif, France

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Eric Baudin Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay University, Villejuif, France

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Corinne Dupuy UMR 8200 CNRS, Gustave Roussy and Paris Saclay University, Villejuif, France

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Alyaksandr V Nikitski Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

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Yuri E Nikiforov Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

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Martin Schlumberger Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay University, Villejuif, France

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Marina N Nikiforova Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

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Sophie Leboulleux Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Paris Saclay University, Villejuif, France
Department of Endocrinology, Hôpitaux Universitaires de Genève, Geneva, Switzerland

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, (I) few inflammatory cells positive with CD163, (K) wild type pattern of P53. (2) A metastatic lesion with PTEN and P53 mutations, the patient died from the disease (high-grade lesion); (B) (hematoxylin and eosin), solid growth with marked atypia and

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Martin K Bakht Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
Laboratory of Molecular Imaging and Therapy, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
Department of Biological Sciences, University of Windsor, Windsor, Ontario, Canada

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Iulian Derecichei Department of Biological Sciences, University of Windsor, Windsor, Ontario, Canada

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Yinan Li Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada

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Rosa-Maria Ferraiuolo Department of Biological Sciences, University of Windsor, Windsor, Ontario, Canada

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Mark Dunning Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK

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So Won Oh Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea

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Abdulkadir Hussein Department of Mathematics and Statistics, University of Windsor, Windsor, Ontario, Canada

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Hyewon Youn Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
Laboratory of Molecular Imaging and Therapy, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
Tumor Microenvironment Global Core Research Center, Seoul National University, Seoul, Korea
Cancer Imaging Center, Seoul National University Hospital, Seoul, Korea

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Keith F Stringer Department of Biological Sciences, University of Windsor, Windsor, Ontario, Canada
Department of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

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Chang Wook Jeong Department of Urology, Seoul National University College of Medicine, Seoul, Korea

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Gi Jeong Cheon Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
Laboratory of Molecular Imaging and Therapy, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

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Cheol Kwak Department of Urology, Seoul National University College of Medicine, Seoul, Korea

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Keon Wook Kang Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
Laboratory of Molecular Imaging and Therapy, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

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Alastair D Lamb Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK

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Yuzhuo Wang Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
Department of Experimental Therapeutics, BC Cancer Research Centre, Vancouver, British Columbia, Canada

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Xuesen Dong Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada

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Lisa A Porter Department of Biological Sciences, University of Windsor, Windsor, Ontario, Canada

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‘Suppressed’ respectively. The values for all three categories were then divided by the maximum value and graphed under their respective categories. Results High-grade CRPC has inconsistent expression of the PSMA gene ( FOLH1 ) FOLH1 expression

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Alexa Childs Department of Oncology, Royal Free London NHS Foundation Trust, London, UK

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Amy Kirkwood Cancer Research UK & UCL Cancer Trials Centre, London, UK

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Julien Edeline UCL Cancer Institute, UCL, London, UK

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Tu Vinh Luong Department of Pathology, Royal Free London NHS Foundation Trust, London, UK

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Jennifer Watkins Department of Pathology, Royal Free London NHS Foundation Trust, London, UK

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Angela Lamarca Institute of Cancer Sciences, University of Manchester/The Christie NHS Foundation Trust, Manchester, UK

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Doraid Alrifai King’s College Hospital NHS Foundation Trust, London, UK

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Phyllis Nsiah-Sarbeng Department of Radiology, Royal Free London NHS Foundation Trust, London, UK

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Roopinder Gillmore Department of Oncology, Royal Free London NHS Foundation Trust, London, UK

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Astrid Mayer Department of Oncology, Royal Free London NHS Foundation Trust, London, UK

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Christina Thirlwell Department of Oncology, Royal Free London NHS Foundation Trust, London, UK
UCL Cancer Institute, UCL, London, UK

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Debashis Sarker King’s College Hospital NHS Foundation Trust, London, UK

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Juan W Valle Institute of Cancer Sciences, University of Manchester/The Christie NHS Foundation Trust, Manchester, UK

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Tim Meyer Department of Oncology, Royal Free London NHS Foundation Trust, London, UK
UCL Cancer Institute, UCL, London, UK

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Introduction Neuroendocrine tumours (NETs) are exceptional in terms of their heterogeneity with respect to clinical behaviour and prognosis. Patients may live with low-grade, indolent tumours for 20years while the outlook for high-grade

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Atsuko Kasajima Department of Pathology, Technical University Munich, Munich, Germany
Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan

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Yuichi Ishikawa Pathology Department, The Cancer Institute Hospital of JFCR, Tokyo, Japan

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Ayaka Iwata Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan

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Katja Steiger Department of Pathology, Technical University Munich, Munich, Germany

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Naomi Oka Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
National Hospital Organization, Sendai Medical Center, Sendai, Japan

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Hirotaka Ishida Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan

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Akira Sakurada Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan

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Hiroyoshi Suzuki National Hospital Organization, Sendai Medical Center, Sendai, Japan

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Toru Kameya Division of Pathology, Shizuoka Cancer Center Hospital and Research Institute, Sizuoka, Japan

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Björn Konukiewitz Department of Pathology, Technical University Munich, Munich, Germany

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Günter Klöppel Department of Pathology, Technical University Munich, Munich, Germany

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Yoshinori Okada Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan

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Hironobu Sasano Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan

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Wilko Weichert Department of Pathology, Technical University Munich, Munich, Germany
Member of the German Cancer Consortium (DKTK)

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likely to metastasize and have a worse prognosis, these two neoplasms share the same phenotype and genotype ( Simbolo et al . 2017 ). In contrast to carcinoids, SCLC and LCNEC are high-grade neuroendocrine carcinomas (NEC) ( Travis et al . 2015

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Anna Karpathakis University College London Cancer Institute, Neuroendocrine Tumour Unit, Paul O'Gorman Building, Huntley Street, London WC1E 6BT, UK
University College London Cancer Institute, Neuroendocrine Tumour Unit, Paul O'Gorman Building, Huntley Street, London WC1E 6BT, UK

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Martyn Caplin University College London Cancer Institute, Neuroendocrine Tumour Unit, Paul O'Gorman Building, Huntley Street, London WC1E 6BT, UK

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Christina Thirlwell University College London Cancer Institute, Neuroendocrine Tumour Unit, Paul O'Gorman Building, Huntley Street, London WC1E 6BT, UK
University College London Cancer Institute, Neuroendocrine Tumour Unit, Paul O'Gorman Building, Huntley Street, London WC1E 6BT, UK

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%) grades, whereas in the USA, tumours are graded as ‘well’ and ‘poorly’ differentiated where ‘well’ equates to low–intermediate-grade and ‘poorly’ equates to high-grade tumours. The current staging systems are reviewed by Kulke et al . (2011) . The most

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Jonathan R Strosberg Department of Medicine, Division of Cancer Medicine, Istituto di Oncologia, Novartis International AG, Novartis Pharmaceuticals Corporation, Sarah Cannon Research Institute, University of Paris VII and Beaujon Hospital, Digestive Oncology, Uppsala University Hospital, Department of Hepatology and Gastroenterology, Moffitt Cancer Center, Tampa, Florida, USA

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James C Yao Department of Medicine, Division of Cancer Medicine, Istituto di Oncologia, Novartis International AG, Novartis Pharmaceuticals Corporation, Sarah Cannon Research Institute, University of Paris VII and Beaujon Hospital, Digestive Oncology, Uppsala University Hospital, Department of Hepatology and Gastroenterology, Moffitt Cancer Center, Tampa, Florida, USA

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Emilio Bajetta Department of Medicine, Division of Cancer Medicine, Istituto di Oncologia, Novartis International AG, Novartis Pharmaceuticals Corporation, Sarah Cannon Research Institute, University of Paris VII and Beaujon Hospital, Digestive Oncology, Uppsala University Hospital, Department of Hepatology and Gastroenterology, Moffitt Cancer Center, Tampa, Florida, USA

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Mounir Aout Department of Medicine, Division of Cancer Medicine, Istituto di Oncologia, Novartis International AG, Novartis Pharmaceuticals Corporation, Sarah Cannon Research Institute, University of Paris VII and Beaujon Hospital, Digestive Oncology, Uppsala University Hospital, Department of Hepatology and Gastroenterology, Moffitt Cancer Center, Tampa, Florida, USA

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Bert Bakker Department of Medicine, Division of Cancer Medicine, Istituto di Oncologia, Novartis International AG, Novartis Pharmaceuticals Corporation, Sarah Cannon Research Institute, University of Paris VII and Beaujon Hospital, Digestive Oncology, Uppsala University Hospital, Department of Hepatology and Gastroenterology, Moffitt Cancer Center, Tampa, Florida, USA

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John D Hainsworth Department of Medicine, Division of Cancer Medicine, Istituto di Oncologia, Novartis International AG, Novartis Pharmaceuticals Corporation, Sarah Cannon Research Institute, University of Paris VII and Beaujon Hospital, Digestive Oncology, Uppsala University Hospital, Department of Hepatology and Gastroenterology, Moffitt Cancer Center, Tampa, Florida, USA

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Philippe B Ruszniewski Department of Medicine, Division of Cancer Medicine, Istituto di Oncologia, Novartis International AG, Novartis Pharmaceuticals Corporation, Sarah Cannon Research Institute, University of Paris VII and Beaujon Hospital, Digestive Oncology, Uppsala University Hospital, Department of Hepatology and Gastroenterology, Moffitt Cancer Center, Tampa, Florida, USA

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Eric Van Cutsem Department of Medicine, Division of Cancer Medicine, Istituto di Oncologia, Novartis International AG, Novartis Pharmaceuticals Corporation, Sarah Cannon Research Institute, University of Paris VII and Beaujon Hospital, Digestive Oncology, Uppsala University Hospital, Department of Hepatology and Gastroenterology, Moffitt Cancer Center, Tampa, Florida, USA

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Kjell Öberg Department of Medicine, Division of Cancer Medicine, Istituto di Oncologia, Novartis International AG, Novartis Pharmaceuticals Corporation, Sarah Cannon Research Institute, University of Paris VII and Beaujon Hospital, Digestive Oncology, Uppsala University Hospital, Department of Hepatology and Gastroenterology, Moffitt Cancer Center, Tampa, Florida, USA

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Marianne E Pavel Department of Medicine, Division of Cancer Medicine, Istituto di Oncologia, Novartis International AG, Novartis Pharmaceuticals Corporation, Sarah Cannon Research Institute, University of Paris VII and Beaujon Hospital, Digestive Oncology, Uppsala University Hospital, Department of Hepatology and Gastroenterology, Moffitt Cancer Center, Tampa, Florida, USA

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differentiated or high-grade NET were not eligible. Furthermore, patients were ineligible if they had received cytotoxic chemotherapy, immunotherapy, or radiotherapy within 4 weeks prior to randomization, or prior therapy with mammalian target of rapamycin

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Peter M Sadow Department of Pathology, WRN219, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114, USA
Department of Pathology, WRN219, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114, USA

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Dora Dias-Santagata Department of Pathology, WRN219, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114, USA

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Zongli Zheng Department of Pathology, WRN219, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114, USA

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Derrick T Lin Department of Pathology, WRN219, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114, USA

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Long Phi Le Department of Pathology, WRN219, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114, USA

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Carmelo Nucera Department of Pathology, WRN219, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114, USA

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aberrant signaling pathways in this rare thyroid carcinoma. Here, we have performed targeted next-generation sequencing (NGS; Zheng et al . 2014 ) in six ATCs (high grade malignant pleomorphic cell neoplasms). We found for the first time that one out of

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