The diagnostic accuracy of opposed-phase and in-phase GRE MR imaging for the differentiation of minimal fat AML and clear cell RCC is poor. In this cohort, low SI on T2-weighted images relative to renal parenchyma and small size suggested minimal fat AML, whereas intratumoral necrosis and large size argued against this diagnosis.

images in clinical medicineT h e ne w e ngl a nd jou r na l o f m e dic i ne n engl j med 359;18 www.nejm.org october 30, 2008 1941A 71-year-old-man presented to the emergency department with dizziness, progressive lethargy, and confusion, which he reported having had for the past 10 days. A complete blood count showed pancytopenia. A peripheral-blood smear (Panel A) and bone marrow aspirate (Panel B) are shown. What is the diagnosis?Editor's note: We invite our readers to submit their answers at www.nejm.org/ mystery. We will publish the diagnosis in the Correspondence section of the December 25, 2008, issue and e-mail it to everyone who submits an answer. All answers must be

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