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This case describes an elderly woman diagnosed over 8 years with diffuse large B-cell lymphoma, polycythemia vera, and angioimmunoblastic T-cell lymphoma, each carrying identical somatic mutations across multiple genes. At least five shared nucleotide mutations were found across specimens, with two co-occurring variants present at variable variant allele frequencies. Findings support a common mutated stem cell giving rise to multiple neoplasms via parallel hematopoietic differentiation pathways.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/common-clonal-origin-of-three-distinct-hematopoietic-neoplasms-in-a-single-patient-b-cell-lymphoma-t-cell-lymphoma-and-polycythemia-vera/340868/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/common-clonal-origin-of-three-distinct-hematopoietic-neoplasms-in-a-single-patient-b-cell-lymphoma-t-cell-lymphoma-and-polycythemia-vera/340868.png","ImageObject",300,407,{"name":92,"@type":93},"Logic","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the main finding of the case study?","Question",{"text":113,"@type":114},"The study reports three distinct hematopoietic neoplasms in a single patient sharing identical somatic mutations across multiple specimens, supporting a common clonal origin.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which three diseases were diagnosed in the patient over time?",{"text":118,"@type":114},"Diffuse large B-cell lymphoma, polycythemia vera, and angioimmunoblastic T-cell lymphoma were diagnosed across an 8-year period.",{"name":120,"@type":111,"acceptedAnswer":121},"How were clonal relationships assessed in this work?",{"text":122,"@type":114},"Clonality was evaluated by identifying shared somatic mutations across different specimen types and tracking variant allele frequencies using genomic methods, including next-generation sequencing described in the study context.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},340868,1790491978,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},1099513958762,"https://ap-avatar.wpscdn.com/avatar/1000023916a998db790?x-image-process=image/resize,m_fixed,w_180,h_180&k=1784791008015729253","C O L D S P R I N G H A R B O R  \nMolecular Case Studies  \nRESEARCH ARTICLE  \nCorresponding author: andrew_evans@urmc. [rochester.edu](rochester.edu)  \n\n| © 2023 Nkosi et al. This article is distributed under the terms of the Creative Commons Attribution License, which permits unrestricted reuse andredistribution provided that the original author and source are credited. |\n| --- |\n| Ontology terms: B-cell lymphoma; hematological neoplasm; increased hemoglobin; increased red blood cell mass; T-cell lymphoma/leukemia |\n\nPublished by Cold Spring Harbor Laboratory Press  \ndoi:10.1101/mcs.a006313  \nCommon clonal origin of three distinct hematopoietic neoplasms in a single patient: B-cell lymphoma, T-cell lymphoma, and polycythemia vera  \nDingani Nkosi,1 Andrew W. Allbee,2 Paul G. Rothberg,1 Jonathan W. Friedberg,3 and Andrew G. Evans1  \n1Department of Pathology and Laboratory Medicine, 2University of Rochester School of Medicine and Dentistry, 3Wilmot Cancer Institute, University of Rochester, Rochester, New York 14642, USA  \nAbstract The potential for more than one distinct hematolymphoid neoplasm to arise from a common mutated stem or precursor cell has been proposed based on findings in primary human malignancies. Particularly, angioimmunoblastic T-cell lymphoma (AITL), which shares a somatic mutation profile in common with other hematopoietic malignancies, has been reported to occur alongside myeloid neoplasms or clonal B-cell proliferations, with identical mutations occurring in more than one cell lineage. Here we report such a case of an elderly woman who was diagnosed over a period of 8 years with diffuse large B-cell lymphoma, polycythemia vera, and AITL, each harboring identical somatic mutations in multiple genes. Overall, at least five identical nucleotide mutations were shared across multiple specimens, with two identical mutations co-occurring at variable variant allele frequencies in all three specimen types. These findings lend credence to the theory that a common mutated stem cell could give rise to multiple neoplasms through parallel hematopoietic differentiation pathways.  \n[Supplemental material is available for this article.]  \nINTRODUCTION  \nCancer stem cell theory predicts that multiple terminally differentiated malignancies mayarise from a single clonal progenitor stem cell. In rare clinical cases, the potential exists to find and document phenotypically distinct tumor types that arise from a common clonal progenitor. Hematopoietic malignancies, in particular, provide an opportunity to study discrete cancers occurring at different times and in disparate locations and evaluate clonality by means of next-generation sequencing (NGS) for shared somatic mutations.  \nWe present a case of a 79-yr-old woman who was initially diagnosed with low-grade Bcell non-Hodgkin lymphoma transformed to diffuse large B-cell lymphoma (DLBCL), followed by polycythemia vera (PV), and then angioimmunoblasticT-cell lymphoma (AITL) within a period of 8 years. Multiple somatic mutations, each occurring at variable variant allele frequencies (VAFs), were identified across all three different specimen types with at least one “founder” genomic alteration, TET2 H1382R, detected in all three specimen types. Our case reinforces previous publications showing multilineage development of hematolymphoid malignancies from a common mutated stem cell precursor.  \nCite this article as Nkosi et al. 2023 Cold Spring Harb Mol Case Stud 9: a006313 1 of 10  \nC O L D S P R I N G H A R B O R  \nMolecular Case Studies  \nClonal origin of three hematologic neoplasms  \nCASE PRESENTATION  \nA 79-yr-old woman developed a sudden onset of right vision loss and right eye ophthalmoplegia. Her past medical history included extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue, diagnosed on small bowel resection 2 years earlier due to obstruction. Magnetic resonance imaging of the head showed a 3-cm mass in the right cavernous sinus extending into the sp","cbCaiaMGHwyuSaU1","https://ap.wps.com/l/cbCaiaMGHwyuSaU1","pdf",7355645,"English","# Abstract\n# Introduction\n# Case Presentation\n## Initial B-cell lymphoma diagnosis and treatment\n## Development of leukocytosis, thrombocytosis, and erythrocytosis","[{\"question\":\"What is the main finding of the case study?\",\"answer\":\"The study reports three distinct hematopoietic neoplasms in a single patient sharing identical somatic mutations across multiple specimens, supporting a common clonal origin.\"},{\"question\":\"Which three diseases were diagnosed in the patient over time?\",\"answer\":\"Diffuse large B-cell lymphoma, polycythemia vera, and angioimmunoblastic T-cell lymphoma were diagnosed across an 8-year period.\"},{\"question\":\"How were clonal relationships assessed in this work?\",\"answer\":\"Clonality was evaluated by identifying shared somatic mutations across different specimen types and tracking variant allele frequencies using genomic methods, including next-generation sequencing described in the study context.\"}]","Common clonal origin of three distinct hematopoietic neoplasms in a single patient - B-cell lymphoma, T-cell lymphoma, and polycythemia vera | PDF",1790039256,25]