The differential diagnosis between blastoid HGBL and CD34 negative B-ALL can be very challenging, especially when a case of blastoid HGBL presents with some unusual features, such as a leukemic presentation with dim CD45 and/or lack of surface light chain expression [1,2,3,4] or when a case of B-ALL lacks CD34 and TdT expression. Here, DNTT is linked to acute lymphoblastic leukemia.