A 63-year-old man comes to the physician because of a 3-month history of fatigue and constipation. He reports having dull pain in the left portion of the midback for 2 weeks that has persisted despite taking ibuprofen. His father died of prostate cancer at 70 years of age. The patient has smoked one pack of cigarettes daily for 45 years. Vital signs are within normal limits. Physical examination shows a left-sided varicocele both in supine and in standing position. Rectal examination shows a symmetrically enlarged prostate with no masses. MRI reveals lytic bone lesions in the corresponding vertebrae and also a right lower pole kidney mass. Histologic examination of the mass is shown below: Which of the following risk factors most likely contributed to this patient's current condition?

Question

A 63-year-old man comes to the physician because of a 3-month history of fatigue and constipation. He reports having dull pain in the left portion of the midback for 2 weeks that has persisted despite taking ibuprofen. His father died of prostate cancer at 70 years of age. The patient has smoked one pack of cigarettes daily for 45 years. Vital signs are within normal limits. Physical examination shows a left-sided varicocele both in supine and in standing position. Rectal examination shows a symmetrically enlarged prostate with no masses.   MRI reveals lytic bone lesions in the corresponding vertebrae and also a right lower pole kidney mass.  Histologic examination of the mass is shown below:  Which of the following risk factors most likely contributed to this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Renal cell carcinoma may present with a combination of hematuria, abdominal mass, or flank pain; however, this triad occurs together in <10% of cases.  Pathology demonstrates rounded, polygonal cells with clear cytoplasm.  Risk factors include smoking, toxin exposure, and certain hereditary disorders (eg, von Hippel-Lindau syndrome).

A 63-Year-Old Man Comes to the Physician Because of a 3-Month