Representative images of histopathological and (molecular) cytogenetic findings of case 1 and case 2. Case 1: Histopathological lymph node (LN) examination revealed dense, sheetlike infiltrates of lymphoid blasts presenting with a starry-sky pattern and extended areas of necrosis not unlike BL (A; Giemsa stain, original magnification ×20). The infiltrates showed a mature B-cell immunophenotype (CD20⁺, CD79⁺, CD10⁺, BCL2⁺, Tdt⁻) with high proliferative activity (B; Ki-67, 70%-97%; original magnification ×20) and minimal reactivity for MYC by immunohistochemistry, in keeping with MYC wild-type status by FISH and rendering an oversight of a cryptic yet functionally relevant MYC rearrangement relatively unlikely (C; original magnification ×20). Bone marrow smear showed significant infiltration of lymphoid blasts with L3 cytomorphology (D; original magnification ×100). R-banded chromosomes showed a complex aberrant karyotype with 4 subclones (E): 46,XY,t(3;16)(p14;q23)?c,t(4;5)(p16;q21), add(6)(q22),add(11)(q23∼24), add(13)(q14),add(22)(q13)[5]/46,sl,–add(6)(q22),add(6)(q27)[4]/46,sdl1,del(6)(q13q14), –add(13)(q14),t(13;17)(q31;q24)[8]/46,sdl2, del(2)(q11.2q24),t(7;17)(p11;q21)[4]/47,sdl2,+der(5)t(4;5)[2].nuc ish(FOXP1x2)[100],(far-cenMYCx2)[100],(cenMYCx2)[100],(MYCx2) [100],(MYCfar-telx2)[100],(D11Z1, ATM,FDX)x2[100],(D11Z1x2,RP11-414G21x2, ETS1x1)[83/100],(KMT2Ax2)[100],(IGHx2)[100],(P53,MPO)x2[100]. Case 2: Excision biopsy revealed compact infiltrates of an aggressive lymphoma, morphologically and immunophenotypically resembling DLBCL with elevated proliferative activity and segmental starry-sky pattern (F-G; hematoxylin and eosin stain, original magnification ×10; 40×) alongside a high proliferative activity (H; Ki-67, 90%-95%; original magnification ×20) and GCB-like immunophenotype; CD20⁺ (I; original magnification ×20), CD79⁺, CD10⁺, BCL2⁺, Tdt⁻. Cytogenetic analysis exhibited rearrangements affecting both MYC and BCL2 genes. FISH image at diagnosis with a custom assay with probes RP11-414G21 (labeled in spectrum green), RP11-629A20 (spectrum orange), and CEP11 for centromere of chromosome 11 (spectrum aqua; Abbott-Vysis, Abbott Park, IL) shows the canonical signal constellation for 11q aberration cases: gain of 11q23.2∼q23.3 evidenced by 3 green signals, loss of 11q24.3 evidenced by 1 red signal, and 2 blue signals of the control probe for the centromere region of chromosome 11 per cell. The 11q aberration pattern was present in 80 of 100 malignant cells, indicating a primary genomic lesion (J; ×63).