De Novo Complex Translocation 9; 22; 19 (Variant Philadelphia+) in Myelodysplastic Syndrome with Excess Blasts: A Case Report

We report adult patients with myelodysplastic syndrome with excess blast (MDS) by the world health organization (WHO) 2016 revision for classification of myeloid neoplasm group. The case had clinical and hematological peculiarities, which had rarely reported and described yet. The cytogenetic alterations were complex translocation 9;22;19 (Variant Philadelphia+) of Philadelphia chromosomes which appeared at different moments of the disease. The patient showed the Ph chromosome with disease transformation at diagnosis and unfortunately, further workup could not be performed as the patient succumbed to her illness and expired. The complex characterization with multiple translocations and the presence of Ph could be a marker of this form of MDS. The association of clinical and hematological findings suggests the possibility of a new group of adult MDS.