A 64-Year-Old Man Comes to the Office Due to 3

question 691

Multiple Choice

A 64-year-old man comes to the office due to 3 months of constant, dull, low back pain that is worse with movement.  The patient has also had intermittent episodes of difficult urination over the last year.  He has no other medical conditions and takes no medications.  The patient smoked a pack of cigarettes daily for 15 years but quit 10 years ago.  Vital signs are within normal limits.  On physical examination, the lungs are clear and heart sounds are normal.  The abdomen is soft and nontender with no hepatosplenomegaly.  Digital rectal examination shows a diffusely enlarged prostate with no nodules.  Laboratory testing reveals a serum creatinine level of 1.9 mg/dL.  Urine dipstick testing is within normal limits, but 24-hour urinary protein excretion is elevated.  Urine microscopy shows waxy, laminated casts.  Imaging of the spine demonstrates diffuse osteopenia and multiple irregular, radiolucent lesions in the thoracic and lumbar vertebrae.  Which of the following histopathologic findings is most likely associated with the development of this patient's bone lesions?

• A)Branching papillae lined by cuboidal cells with overlapping nuclei
• B)Infiltrating glandular cells with substantial adjacent osteoblasts
• C)Large, malignant cells containing keratin and intercellular bridges
• D)Clusters of mature plasma cells and plasmablasts
• E)Sheets of round or polygonal cells with abundant clear cytoplasm

---

Definitions:

British America

Territories in the Americas that were part of the British Empire before gaining independence or being transferred to other countries.

British Empire

A global empire composed of dominions, colonies, protectorates, mandates, and other territories ruled or administered by the United Kingdom between the 16th and early 20th centuries.

1700 to 1763

A historical period marked by colonial expansion, economic changes, and the buildup to the American Revolutionary War.