The clinical presentation, precursor B-cell immunophenotype (CD45(dim), CD19, PAX5, CD10, CD22, cCD22, and cCD79a), negative CD20, and karyotype/FISH results are consistent with a diagnosis of either “B-ALL with MYC rearrangement” in the 2022 ICC classification [7] or “B-ALL/LBL with other defined genetic abnormalities” in the 2022 WHO classification [8]. The gene discussed is CD19; the disease is intrahepatic cholangiocarcinoma.