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Incidence of e-cigarette, or vaping, product use-associated lung injury (EVALI) has been linked to the vaping of tetrahydrocannabinol (THC) products to which vitamin E acetate (VEA) has been added. In this work we vaped THC/VEA mixtures at elevated power levels using a variety of ceramic coil vaping cartridges and a commercially available vaping device, while simultaneously measuring temperature and collecting the vaporized condensate. The collected vapor condensate was analyzed for evidence of VEA decomposition by GC/MS, GC/FT-IR/MS, and LC-APCI-HRMS/MS. Mean temperature maxima for all examined cartridges at the selected power exceeded 430°C, with a range of 375–569°C, well beyond that required for thermal decomposition of VEA. The percent recovery of VEA and Δ9-THC from the vaporized mixture in six cartridges ranged from 71.5 to 101% and from 56.4 to 88.0%, respectively. Analysis of the condensed vaporized material identified VEA decomposition products duroquinone (DQ), 1-pristene, and durohydroquinone monoacetate (DHQMA); a compound consistent with 4-acetoxy-2,3,5-trimethyl-6-methylene-2,4-cyclohexadienone (ATMMC) was also detected. The concentration of DQ produced from vaporization of the THC/VEA mixture in one cartridge was found to be 4.16 ± 0.07 μg per mg of vapor condensate.

Carcinoma showing thymus-like elements (CASTLE) is a rare tumor, most commonly found in the thyroid gland. Here we report a case of CASTLE tumor localized to the parotid gland, recognized in retrospect after a late manifestation of symptomatic pleural carcinomatosis. The original tumor in the parotid gland was treated by surgery followed by radiotherapy. Ten years later, a metastatic disease with recurrent pleural effusions occurred. Pleural carcinomatosis was strongly positive for CD5, CD117, and p63 as was the original tumor of the parotid, which allowed the diagnosis of a CASTLE tumor. Additionally, the pleural tumor expressed high levels of programmed death ligand 1 (PD-L1), and the patient underwent treatment with the monoclonal PD-L1 inhibitor pembrolizumab achieving a partial remission. To the best of our knowledge, this is the first patient with a metastatic CASTLE tumor treated with a PD-L1 inhibitor.