The advent of immune-checkpoint inhibitors (ICI) in modern oncology has significantly improved survival in several cancer settings. A subgroup of women with breast cancer (BC) has immunogenic infiltration of lymphocytes with expression of programmed death-ligand 1 (PD-L1). These patients may potentially benefit from ICI targeting the programmed death 1 (PD-1)/PD-L1 signaling axis. The use of tumor-infiltrating lymphocytes (TILs) as predictive and prognostic biomarkers has been under intense examination. Emerging data suggest that TILs are associated with response to both cytotoxic treatments and immunotherapy, particularly for patients with triple-negative BC. In this review from The International Immuno-Oncology Biomarker Working Group, we discuss (a) the biological understanding of TILs, (b) their analytical and clinical validity and efforts toward the clinical utility in BC, and (c) the current status of PD-L1 and TIL testing across different continents, including experiences from low-to-middle-income countries, incorporating also the view of a patient advocate. This information will help set the stage for future approaches to optimize the understanding and clinical utilization of TIL analysis in patients with BC.

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An unusual case presenting to the otolaryngologist as pulsatile tinnitus is discussed. Fowler points out that the circulatory response to anemia is increased cardiac output. There is associated tachycardia and increased arterial pulse pressure. Because of this increased flow state and turbulence, systolic bruits, venous hums, and "capillary" pulsations are found. This increased flow state is perceived in the ear as a transmitted pulsatile tinnitus. The successful treatment of this patient's pernicious anemia corrected the hyperdynamic circulatory state, and resulted in disappearance of her tinnitus.