Somatic POLE Mutation and Ultra-Hypermutated Genotype in a De Novo High-Grade, Isocitrate Dehydrogenase Wild-Type Glioma: Treatment Implications.

Pembrolizumab leads to a durable response in ultra-hypermutated, high-grade, glioma.

Granular cell tumor in the pulmonary tree.

Granular cell tumors are often benign growths of the tongue, dermis, and subcutaneous tissues. Rarely, we see production in the pulmonary system. These schwannian and histiocyte origin tumors in the lungs are called pulmonary granulocyte tumors. While granular cell tumors are rare, pulmonary granulocyte tumors are even rarer, with less than eighty-five cases described since the 1930s. Herein, we introduce these rare growths and provide a review of known epidemiological evidence and pathophysiology.

Vitamin D Level Testing in an Urban Midwest Clinic: To Test or Not to Test?

Vitamin D deficiency (VDD) is significantly higher among urban populations in the U.S. Midwest, with African Americans being disproportionately affected. There is ongoing debate surrounding who and how often individuals should be screened for VDD. This study aimed to understand the prevalence of VDD, associated risk factors, and discrepancies in testing at an urban-based internal medicine residency clinic. Data were retrospectively collected on all adult patients seen by the clinic during 2018 and descriptive statistical analysis performed. Among 3976 total patients (mean age: 53 years), 18% (n=698) had vitamin D levels analyzed, with deficiency found in 71% of those tested. Mean age of the tested cohort was 59 years, and women (68%) and African Americans (72%) were found more likely to be tested. Women and patients with certain medical conditions were more likely to be tested (P<0.02 for all) but were not more likely to have VDD. Individuals with a diagnosis of chronic kidney disease were less likely to have VDD (P=0.002). Vitamin D levels typically showed improvement after retesting. A low testing rate could contribute to missed diagnoses. Overall, this study revealed that differences in rate of testing do not necessarily correlate to patients' demographical risk of VDD. Clinicians may benefit from a standardized vitamin D testing protocol.

Patients Recently Treated for B-lymphoid Malignancies Show Increased Risk of Severe COVID-19.

Patients with B-lymphoid malignancies have been consistently identified as a population at high risk of severe COVID-19. Whether this is exclusively due to cancer-related deficits in humoral and cellular immunity, or whether risk of severe COVID-19 is increased by anticancer therapy, is uncertain. Using data derived from the COVID-19 and Cancer Consortium (CCC19), we show that patients treated for B-lymphoid malignancies have an increased risk of severe COVID-19 compared with control populations of patients with non-B-lymphoid malignancies. Among patients with B-lymphoid malignancies, those who received anticancer therapy within 12 months of COVID-19 diagnosis experienced increased COVID-19 severity compared with patients with non-recently treated B-lymphoid malignancies, after adjustment for cancer status and several other prognostic factors. Our findings suggest that patients recently treated for a B-lymphoid malignancy are at uniquely high risk for severe COVID-19. SIGNIFICANCE: Our study suggests that recent therapy for a B-lymphoid malignancy is an independent risk factor for COVID-19 severity. These findings provide rationale to develop mitigation strategies targeted at the uniquely high-risk population of patients with recently treated B-lymphoid malignancies. This article is highlighted in the In This Issue feature, p. 171.

Lung Cancer Presenting as Skin Metastasis of the Back and Hand: A Case Series and Literature Review.

Lung cancer has the highest mortality of all cancers in the United States. The incidence of lung cancer with metastases to the skin varies between 1-12%, with the highest incidence seen in men. Here, we present two cases of lung cancer presenting as skin metastasis. The first patient was an 80-year-old African American male who presented to the hospital for evaluation of a right upper back mass. A few months prior to admission, he was found to have a left lung mass on CT scan of the chest, he underwent biopsy which showed poorly differentiated SCC of the lung. He also had a skin biopsy which showed poorly differentiated carcinoma in the dermis consistent with metastatic SCC. He was started on chemotherapy, but could not tolerate it. He was accepted to hospice. The second patient was a 78-year-old Hispanic female who presented to the hospital with dyspnea, and a dry cough. Upon physical examination, a 2 × 2 cm ulcerated, wart-like nodule on the right palm was noted. Subsequent CT scan of the chest showed a partial collapse of the right middle lobe. A biopsy of the hand mass revealed well-to-moderately differentiated metastatic SCC favoring lung origin. A bronchoscopy biopsy showed invasive SCC. Subsequently her condition worsened and she passed away. Metastasis to the skin is an unusual presenting symptom of lung cancer. It is therefore essential to consider metastasis as a diagnosis in a patient with both a skin lesion and a smoking history.