With overwhelming evidence supporting the role of genetic events in clinical outcome, prognosis, and treatment, the 2022 ICC does not require morphological dysplasia for a diagnosis of MDS in the presence of key molecular and cytogenetics features, which include mutated SF3B1, del(5q), and −7/del(7q) [5]. The gene discussed is SF3B1; the disease is intrahepatic cholangiocarcinoma.