Notably, the patient’s long-term vegetarian diet and potential malnutrition(Hemoglobin: 59.00 g/L; Prealbumin: 15.3 mg/dL; Albumin: 34.7 g/L) may have contributed to immune compromise, which is consistent with the growing evidence linking immune dysregulation to the development of MPMNs (6). This evidence concerns the gene ALB and nutritional deficiency disease.