SECTION EDITOR: EDWARD B. STELOW, MD
A 49-year-old male veteran with a history of overseas deployment to Iraq presented 7 years after his most recent deployment. He reported a several-month history of an enlarging painful ulcer in the center of his tongue, with dysphagia, odynophagia, and a 9-kg weight loss. His medical history was remarkable for scattered nonnecrotizing liver granulomas that had been diagnosed from a liver biopsy 5 years earlier as well as for elevated liver enzyme levels (alanine transaminase, 127 IU/L; aspartate transaminase, 89 IU/L; and alkaline phosphatase, 474 IU/L [to convert liver enzyme values to microkatals per liter, multiply by 0.0167]), splenomegaly, and chronic thrombocytopenia.
Meacham RK, LeSueur JR, Sebelik ME, Hodges JM. Pathology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2012;138(8):777. doi:10.1001/archoto.2012.1300