USMLE-Rx Step 1 Qmax Challenge #1777

Check out today’s Step 1 Qmax Question Challenge.

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A 45-year-old white male, with no significant past medical history, presents with a 3-month history of waking at night drenched in sweat, and a 20-lb weight loss. He has smoked 1 pack of cigarettes per day for the past 30 years. A recent chest X-ray did not show any masses. Labs on admission demonstrated a hemoglobin of 12 g/dL, hematocrit of 36%, MCV of 74 ?m3, and platelet count of 250,000/mm3. Urinalysis shows:

Osmolarity: 600 mOsm/kg H2O
Protein <0.15 g/24h
Sodium of 45 mEq/L/d
Negative ketones
Negative nitrites
Negative leukocyte esterase
20 RBC/hpf
<2 WBC/hpf
40 squamous cells
No casts, bacteria, or yeast

An intravenous pyelogram is inconclusive. The treating urologist acquires several biopsies from the genitourinary system. The histopathologic preparation of one such biopsy is shown.

What condition does this patient have?

A. Clear cell carcinoma
B. Oncocytoma
C. Small cell carcinoma
D. Squamous cell carcinoma of the bladder
E. Transitional cell carcinoma
F. Wilms tumor

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