Myeloproliferative neoplasms (MPNs) encompass a heterogeneous group of chronic, clonal haematopoietic stem cell neoplasms that harbor the propensity to undergo leukaemic transformation. Epidemiological data on MPNs especially pertaining to non-Caucasian populations is limited, and the molecular pathogenesis of MPN remains unclear. Although the discovery of MPN driver mutations in JAK2, MPL and CALR in the last decade has revolutionised disease management, the mutations are not specific for any MPN subtype. The management of MPNs is further challenged by substantial genetic and phenotypic heterogeneity that exist between and within MPN subtypes as well as other myeloid diseases. In this review, we focus on the classical Philadelphia chromosome (Ph)-negative MPNs – polycythaemia vera (PV), essential thrombocythaemia (ET), and primary myelofibrosis (PMF); providing an overview on the current understanding of the disease at a clinical and molecular standpoint while discussing the present challenges and future opportunities in the management of MPNs.

Mullerian agenesis or Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH) Type-II is a congenital defect in the Mullerian duct that results in the absence of a uterus in women. The aetiology of this syndrome is unknown and has been considered a sporadic genetic disease. MRKH, together with anorectal anomaly, is an extremely rare condition and has only been reported in a few cases without any information on genetic analysis. This study investigated the mutational profile of a girl diagnosed with MRKH and anorectal anomalies with rectovaginal fistula. The whole exome sequencing (WES) trio-genetic analysis of a 5-year-old Malaysian girl diagnosed with MRKH (having anorectal anomaly with rectovaginal fistula) was performed together with her normal parents, using the Ion AmpliSeq Exome RDY kit (ThermoFisher Scientific, USA). Data were analysed using Torrent Suite v.5.0.4 and annotated using ANNOVAR. Single nucleotide polymorphisms (SNPs) with an allele frequency >0.01 were excluded, and the remaining variants were filtered based on de novo mutations, autosomal recessive, and autosomal recessive genetic traits. Related genes were analysed by biological pathway analysis (g:Profiler) and protein-protein interaction (HIPPIE v.2.3, STRING v.11.5, dan GeneMANIA). A total of 36 mutations were identified, and two of them, the LHX5 (p.P358Q), inherited from the father, and CFTR (p.R1158X), inherited from the mother. There were 28 de-novo mutations from 28 genes. All genes were involved in 27 biological processes that connected with 23 interactions, and are likely to cause MRKH syndrome in this patient.