This article reviews particular subgroup of B-cell lymphoma, called "double-hit" lymphoma (DHL) because of its distinct aberrations-related genes influencing various processes such as apoptosis, differentiation, and proliferation. Recent studies indicate that tumorigenesis is a complex process involving multiple genes, genetic abnormalities, including gene mutations, deletions, and chromosomal alterations. Chromosomal aberrations are not affecting only basic cellular life preserving activities such as cell proliferation, differentiation, apoptosis, and signal transduction, but are also indispensible for evaluation of lymphoma occurrence, progression, and prognosis as well differential diagnosis and other aspects assessment. DHL is group accompanied by IGH-BCL2 and MYC rearrangement, behaving highly aggressively, with a complex and distinct karyotype which can not be extrapolated solely by morphological pathological assessment, since it has not been entirely characteristic. Therefore, we are reviewing possible effects of multiple genetic rearrangements, particular genes mutations, and developing hypothesis due which pathophysiology mechanisms DHL accomplish synergistic malignant potential.