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In some of these cases there is evidence that the leukemia derives from a pluripotent primitive clone present in the original germ cell tumor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>We present a highly unusual case of a 23-year-old man of South Asian origin with a history of Klinefelter\u2019s syndrome who initially developed mediastinal non seminomatous GCT. Following treatment with surgery and standard chemotherapy he went on to develop three different hematological malignancies of distinct lineages in sequential fashion over a short time period. Despite treatment with multiple intensive chemotherapy regimens and a matched unrelated donor allogeneic stem cell transplant, he died 41\u00a0months after initial diagnosis of his GCT and 10\u00a0months after the first diagnosis of hematological malignancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This is an extreme case that highlights the pluripotency and aggressiveness of these GCT-derived hematological malignancies, and the need for novel therapeutic approaches.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s13256-020-02558-8","type":"journal-article","created":{"date-parts":[[2020,11,17]],"date-time":"2020-11-17T00:12:19Z","timestamp":1605571939000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Three distinct hematological malignancies from a single germ cell tumor: a case report"],"prefix":"10.1186","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5320-8193","authenticated-orcid":false,"given":"M.","family":"Spencer Chapman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. 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A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"222"}}