A 75-Year-Old Man Presented to the Office Complaining of Severe

A 75-year-old man presented to the office complaining of severe lower back pain. The pain started 2 weeks ago. The patient did not receive any trauma. The patient describes that in the last 4 months he has had difficulty in initiating urination and a weak urinary stream. The patient has a medical history of chronic hypertension and hyperlipidemia. The patient has been smoking one pack of cigarettes for the last 35 years. On examination, there is tenderness in the lower side of the back. A bone scan revealed an osteoblastic lesion in the lumbar region of the vertebrae. Which of the following structures is involved in the spread of the primary lesion?

A) Azygos veins
B) Internal iliac lymph nodes
C) Pampiniform plexus
D) Paraaortic lymph nodes
E) Prostatic venous plexus
F) Vertebral artery

Correct Answer:

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