A 65-year-old man comes to the office for evaluation of blood in the urine. The patient has no abdominal pain, urinary frequency, or urgency. He has hypertension, type 2 diabetes mellitus, and stage II chronic kidney disease. He quit smoking 10 years ago and had smoked a pack of cigarettes daily for 30 years. Laboratory evaluation shows a hematocrit of 56%. Chest imaging shows multiple round lesions in both lungs. Biopsy of one of the lesions reveals the microscopic findings shown below. This patient's metastatic disease most likely originated from which of the following organs?

Question

A 65-year-old man comes to the office for evaluation of blood in the urine.  The patient has no abdominal pain, urinary frequency, or urgency.  He has hypertension, type 2 diabetes mellitus, and stage II chronic kidney disease.  He quit smoking 10 years ago and had smoked a pack of cigarettes daily for 30 years. Laboratory evaluation shows a hematocrit of 56%.  Chest imaging shows multiple round lesions in both lungs.  Biopsy of one of the lesions reveals the microscopic findings shown below.  This patient's metastatic disease most likely originated from which of the following organs?

Quizplus · Accepted Answer

Eductional Objective: Clear cell carcinoma is the most common subtype of renal cell carcinoma and is composed of large, rounded, or polygonal cells with clear cytoplasm.  These tumors are often detected incidentally at an advanced stage; the lung is the most common site for metastasis, followed by osteolytic bone and liver.

A 65-Year-Old Man Comes to the Office for Evaluation of Blood