Pharyngeal liposarcomas are very rare; still more rare are dedifferentiated liposarcomas in the pharynx. An 82-year-old man presented with dysphagia, voice changes, weight loss, nasal regurgitation of liquids, and coughing spells. A 3.5 cm mass was identified in the hypopharynx. The mass was biopsied and diagnosed as a benign fibroepithelial polyp. Continued symptoms and airway obstruction prompted a pharyngectomy, and the mass was then diagnosed as dedifferentiated liposarcoma. Due to infrequency and subtle histological findings, liposarcomas of the head and neck can be misdiagnosed and recur.

A 39-year-old man with a history of intravenous drug abuse and hepatitis C virus infection was found unresponsive on the street in Tucson, Arizona. His temperature was 41.8°C and he was tachycardic, hypotensive, and hypoxemic. A complete blood count showed white blood cell count of 17.8 3 10 9 /L, red blood cell count of 5.21 3 10 12 /L, hemoglobin level of 164 g/L, mean corpuscular volume of 97.6 fL, red cell distribution width of 13.8%, and platelet count of 386 3 10 9 /L. A urine drug screen detected opiates and amphetamines. The peripheral blood showed absolute neutrophilia with a shift to immaturity and botryoidtype hypersegmentation of the neutrophils (65% affected; panel A, original magnification 3100; Wright-Giemsa stain), monocytes (panel B, original magnification 3100; Wright-Giemsa stain), and lymphocytes. These morphologic features returned to normal 24 hours after hydration and cooling. Although neutrophil hypersegmentation can be seen in vitamin B 12 and folate deficiencies, heat shock, or amphetamine overdose, the morphologic features differ depending on the underlying cause. In nutritional deficiencies, the number of segments is increased up to 5, 6, and rarely 7. Conversely, in heat shock and amphetamine overdose, the neutrophils, monocytes, and lymphocytes are hypersegmented up to 9 lobes emanating from a single centriole with radial segmentation: the so-called botryoid type. Leukocyte morphology and mean corpuscular volume can help differentiate the diagnosis.For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit http://imagebank.hematology.org.

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Acute myelogenous leukemia is a hematologic malignancy defined by the presence of myeloid blasts causing bone marrow infiltration. Evaluation and workup of acute myelogenous leukemia is based on comprehensive medical history, physical examination, laboratory evaluation, and bone marrow sampling. Magnetic resonance (MR) imaging is the study of choice in the evaluation of this disease including the initial evaluation, treatment follow-up, and complications. Herein, we report a case of relapse of the acute myelogenic leukemia in an adult patient who presented with diffuse periostitis in his lower extremities diagnosed on MR imaging and confirmed on Technetium bone scan, which also showed periostitis along the bilateral humeri. To our knowledge, this was not previously reported in the English literature.