Check out today’s Step 2 CK Qmax Question Challenge.
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A 63-year-old man presents to his physician because of low back pain and one episode of gross hematuria. He has had lower back pain, described as a dull ache just to the left of his spine, for 1 month. The pain is constant and does not radiate. He has no history of nephrolithiasis or back trauma. His temperature is 36.4°C (97.6°F) and heart rate is 68 beats/min. His abdomen is soft and nontender. He has no costovertebral angle tenderness and is able to lie on the examining table comfortably for the duration of the examination. A urine sample is noted to contain gross mucus. A plain film of the kidney and bladder shows no calcifications or other abnormalities. An ultrasound image of the kidneys and bladder shows a hypoechoic mass containing more focal hyperechoic structures located at the dome of bladder. The mass arises from the anterosuperior surface of the bladder in the midline, and is 4-6 cm in diameter. CT confirms the presence of this lesion, but does not show any extension outside of the bladder or any regional lymphadenopathy. A biopsy of the lesion is read as adenocarcinoma.
Which of the following is most likely structure of origin?
C. Trigone of the bladder
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