Abstract Objectives High-grade B-cell lymphoma (HGBL), introduced in the 2016 World Health Organization (WHO) revised fourth edition classification, included cases defined by MYC and BCL2 and/or BCL6 rearrangements or by high-grade morphology. Diagnostic criteria and nomenclature for these lymphomas were refined in the 2022 WHO fifth edition (WHO-5) classification and International Consensus Classification (ICC). This review describes our approach to the diagnosis of HGBL. Methods Two cases are presented illustrating how we diagnose HGBL, including 1 case harboring MYC and BCL6 rearrangements and a second showing TdT expression in an HGBL with MYC and BCL2 rearrangements. The ways in which these cases are distinguished from other lymphomas with high-grade features and the appropriate nomenclature using WHO-5 and ICC classifications are emphasized. Results An HGBL diagnosis requires integration of morphology, immunophenotype, and genetics and exclusion of other lymphomas with high-grade morphology, including Burkitt lymphoma, B-lymphoblastic leukemia/lymphoma (B-LBL/ALL), and blastoid mantle cell lymphoma. A diagnosis of HGBL/large B-cell lymphoma with 11q aberration should also be considered in certain patient populations. Conclusions High-grade B-cell lymphomas are subclassified based on morphologic and genetic features. There are differences in the nomenclature and definition of these lymphomas in the WHO-5 and ICC classifications. Distinguishing HGBLs from other mature B-cell lymphomas and B-LBL/ALL is critical so that patients receive appropriate treatment.

Erika M Moore

Sarah E Gibson

American Journal of Clinical Pathology

美国临床病理学杂志 (AJCP) 是美国临床病理学会和临床实验室医师和科学家学会的官方期刊。它是出版有关人类疾病的新型解剖病理学和实验室医学观察文章的领先国际期刊。 AJCP 强调的文章侧重于将不断发展的技术应用于疾病和状况的诊断和表征，以及与改善患者护理有直接联系的文章。

The American Journal of Clinical Pathology is the official journal of the American Society for Clinical Pathology and the Society of Clinical Laboratory Scientists. It is a leading international journal that publishes innovative articles on anatomic pathology and laboratory medicine observations related to human diseases. The journal emphasizes articles that focus on the application of evolving technologies in the diagnosis and characterization of diseases and conditions, as well as those that are directly linked to improving patient care.

《American Journal of Clinical Pathology》是美国临床病理学会和临床实验室医师与科学家学会的官方期刊。该期刊是国际领先的出版有关人类疾病的解剖病理学和实验室医学观察文章的期刊。它强调的文章主要集中在将不断发展的技术应用于疾病和病症的诊断与表征，以及与改善患者护理直接相关的研究。

Category	Quartile
医学	4
医学, 病理学	3

How I diagnose high-grade B-cell lymphoma

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