A tumor mutational burden of 103 mutations per megabase (where 19 mutations per megabase are considered a high tumor mutation burden) and 19 genomic alterations including amplification of programmed death-ligand 1 (PD-L1), programmed death-ligand 2 (PD-L2) and Janus kinase 2 (JAK2) by sequencing; indeed, his metastatic disease demonstrated an exceptional response to anti-programmed death 1 (PD1) therapy [20,21]. This evidence concerns the gene PDCD1LG2 and metastatic neoplasm.