Recurrent cytogenetic abnormalities are demonstrated in approximately fifty percent cases of Myelodysplastic syndromes (MDS) found as result of genomic instability accredited to the presence of oncogenic genetic mutations. Over the years the molecular basis of MDS has remained elusive but major breakthroughs have been made recently in elucidating the molecular pathogenesis of this entity by employing the sophisticated technology of next generation sequencing. We are reporting here a circumstantial account of a case of Myelodysplastic syndrome with ringed sideroblasts and multilineage dysplasia (MDS-RS-MLD) with normal karyotype and co-occurrence of oncogenic mutations involving SF3B1, CSF3R and RUNX1, deciphered through next generation sequencing. The reports pertinent to the association of SF3B1 mutation to other driver mutations are relatively sparse. It most commonly exists in association with DNMT3A and the two together play an important role in evolution of MDS. RUNX1 mutations are the second common mutations to exist in association with SF3B1. This case points not only towards the diagnostic importance of these somatic driver mutations but also demands for a more refined prognostic model with the integration of somatic driver mutations so that better prognostic groups can be assigned and better risk adapted treatment can be offered to individual MDS patients.
 

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