{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T11:10:11Z","timestamp":1790248211803,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":266,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100010753","name":"National Health Laboratory Service","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010753","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Hematology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multiple primary malignant neoplasms (MPMNs) diagnosed synchronously are rare, with an incidence of less than 1%. The occurrence of triple synchronous malignancies is exceedingly uncommon, and to our knowledge, no prior reports describe the concurrent presentation of a myeloproliferative neoplasm, plasma cell dyscrasia and breast cancer. Such cases pose considerable diagnostic and therapeutic challenges, particularly in settings with limited access to advanced molecular testing and oncologic therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>\n                      A 67\u2010year\u2010old woman presented with a pathological femoral fracture, marked leucocytosis and thrombocytosis. Histological examination of the fracture site revealed a kappa\u2010restricted plasmacytoma meeting diagnostic criteria for multiple myeloma (R\u2010ISS Stage 3). Bone marrow biopsy demonstrated hypercellularity with atypical clustered megakaryocytes, consistent with prefibrotic primary myelofibrosis, and molecular analysis confirmed a\n                      <jats:italic>JAK2 V617F<\/jats:italic>\n                      mutation. During evaluation, a right breast mass was confirmed on core biopsy as an invasive carcinoma with focal mucinous differentiation (ER\/PR\u2010positive, HER2\u2010negative and Ki\u201067 25%), consistent with a luminal B\u2013like profile. The patient commenced therapy with melphalan and prednisone for myeloma and anastrozole for breast carcinoma, with multidisciplinary input guiding treatment sequencing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case represents an exceptionally rare triad of synchronous malignancies spanning myeloid, plasma\u2010cell and epithelial lineages. While myeloproliferative neoplasms are associated with an elevated risk of secondary neoplasia, the simultaneous occurrence of three independent malignancies raises the possibility of shared pathogenic mechanisms such as clonal haematopoiesis or an underlying germline predisposition. The presentation highlights the diagnostic complexity of distinguishing independent primaries from metastatic disease and illustrates the importance of maintaining diagnostic vigilance. Limited access to next\u2010generation sequencing and novel therapies further complicates management in resource\u2010constrained healthcare environments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Triple synchronous primary malignancies are exceedingly rare and diagnostically challenging. This case emphasises the necessity of a systematic, multidisciplinary approach to evaluation and management, even in low\u2010resource settings, to ensure accurate diagnosis and optimal coordination of care across multiple oncologic pathologies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/crh\/7459223","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:33:35Z","timestamp":1790246015000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Synchronous Triple Malignancy Presentation of Multiple Myeloma and Prefibrotic Primary Myelofibrosis in a Patient With Mucinous Breast Carcinoma: A Case Report From Rural South Africa"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7509-1010","authenticated-orcid":false,"given":"Michael A.","family":"Linstr\u00f6m","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9645-9495","authenticated-orcid":false,"given":"Dean C.","family":"Mitchell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5609-8591","authenticated-orcid":false,"given":"Riyaadh","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2139-8217","authenticated-orcid":false,"given":"Robert K.","family":"Lohlun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-021-08766-9"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.21037\/ace-19-40"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.31557\/apjcc.2024.9.4.699-704"},{"key":"e_1_2_12_4_2","article-title":"Survival and Clinical Characteristics of Patients With Multiple Primary Cancers: A Hospital-Based Study","volume":"12","author":"Zhao J.","year":"2019","journal-title":"International Journal of Clinical and Experimental Medicine"},{"key":"e_1_2_12_5_2","first-page":"1975","volume-title":"National Cancer Institute","author":"Howlader N.","year":"2011"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-14-272"},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2021.101900"},{"key":"e_1_2_12_8_2","doi-asserted-by":"publisher","DOI":"10.3892\/ol.2023.14014"},{"key":"e_1_2_12_9_2","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2017-219237","article-title":"Triple Synchronous Primary Malignancies: A Rare Occurrence","author":"Katz H.","year":"2017","journal-title":"BMJ Case Reports"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.prp.2013.03.007"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/7953745"},{"key":"e_1_2_12_12_2","volume-title":"Haematolymphoid Tumors","author":"WHO Classification of Tumours Editorial Board","year":"2022"},{"key":"e_1_2_12_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(14)70442-5"},{"key":"e_1_2_12_14_2","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2015.61.2267"},{"key":"e_1_2_12_15_2","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2010.32.2446"},{"key":"e_1_2_12_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-025-06191-7"},{"key":"e_1_2_12_17_2","volume-title":"Breast Tumours","author":"WHO Classification of Tumours Editorial Board","year":"2019"},{"key":"e_1_2_12_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12672-025-03146-2"},{"key":"e_1_2_12_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/tbj.12621"},{"key":"e_1_2_12_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2024.103760"},{"key":"e_1_2_12_21_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-025-02654-y"},{"key":"e_1_2_12_22_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.v126.23.1855.1855"},{"key":"e_1_2_12_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/20406207251314696"},{"key":"e_1_2_12_24_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers12103061"},{"key":"e_1_2_12_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.5666"},{"key":"e_1_2_12_26_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-09604-z"},{"key":"e_1_2_12_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2017.07.020"},{"key":"e_1_2_12_28_2","article-title":"TET2 Promotes Anti\u2010Tumor Immunity by Governing G\u2010Mdscs and CD 8 T\u2010Cell Numbers","volume":"21","author":"Li S.","year":"2020","journal-title":"EMBO Reports"},{"key":"e_1_2_12_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/cas.15294"},{"key":"e_1_2_12_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.28988"},{"key":"e_1_2_12_31_2","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1001\/jama.1978.03290060037009","article-title":"Minimal Genetic Findings and Their Cancer Control Implications. A Family With the Cancer Family Syndrome","volume":"240","author":"Lynch H. T.","year":"1978","journal-title":"JAMA"}],"container-title":["Case Reports in Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crh\/7459223","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/crh\/7459223","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crh\/7459223","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:33:37Z","timestamp":1790246017000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/crh\/7459223"}},"subtitle":[],"editor":[{"given":"Suraiya","family":"Saleem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/crh\/7459223"],"URL":"https:\/\/doi.org\/10.1155\/crh\/7459223","archive":["Portico"],"relation":{},"ISSN":["2090-6560","2090-6579"],"issn-type":[{"value":"2090-6560","type":"print"},{"value":"2090-6579","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-11-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"7459223"}}