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1
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Youssef M, Sewell J, Grills R. Unrecognised paraganglioma of the urinary bladder precipitating hypertensive crisis. BMJ Case Rep 2024; 17:e259283. [PMID: 38684348 PMCID: PMC11146354 DOI: 10.1136/bcr-2023-259283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
Bladder paragangliomas (bPGLs) account for only 0.06% of all bladder tumours, most commonly presenting with post-micturition syncope and hypertensive crisis. Silent paragangliomas are very rare, and failure to recognise them in the perioperative setting can precipitate a hypertensive crisis in the absence of sufficient alpha-blockade. Here, we describe a case of unrecognised bPGL in a woman with pre-existing hypertension and a single prior episode of haematuria thought to be related to urothelial carcinoma. She was found to have a low-grade non-invasive papillary urothelial carcinoma (potentially the cause of her haematuria) and an unrelated vascular-appearing tumour causing hypertensive crisis and broad complex tachycardia on resection. This was confirmed to be a bPGL on histology for which she underwent definitive management with a partial cystectomy following blood pressure management.
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Affiliation(s)
- Marina Youssef
- Urological Surgery, Barwon Health, Geelong, Victoria, Australia
| | - James Sewell
- Urological Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Richard Grills
- Deakin University School of Medicine, Geelong, Victoria, Australia
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2
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Gauci Z, Giordano Imbroll M, Sciberras Giusti E, Agius S, Gruppetta M. Metastatic paraganglioma presenting with spinal cord compression requiring urgent surgery. BMJ Case Rep 2023; 16:e256052. [PMID: 37699744 PMCID: PMC10503315 DOI: 10.1136/bcr-2023-256052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
We report a rare case of a functional bladder paraganglioma diagnosed in a young man who presented with acute compressive thoracic myelopathy secondary to vertebral metastasis. A histological diagnosis of a metastatic paraganglioma was made following biopsy of a rib lesion. CT revealed a lesion in the inferior wall of the bladder, which demonstrated avid uptake on 68Ga-DOTATATE PET/CT. Serum metanephrine levels were more than 40 times the upper limit of normal. The patient was hypertensive and treatment with doxazosin was initiated. In view of neurological deterioration, he required urgent spinal decompression to preserve neurological function and prevent permanent paraplegia. Despite inadequate alpha-blockade, surgery was successful, and the perioperative course was uneventful. Alpha-blockade was subsequently optimised. Treatment with cyclophosphamide, vincristine and dacarbazine was started but, in view of disease progression, treatment was subsequently changed to sunitinib.
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Affiliation(s)
- Zachary Gauci
- Department of Endocrinology and General Medicine, Mater Dei Hospital, Msida, Malta
| | | | | | - Shawn Agius
- Department of Neurosciences, Mater Dei Hospital, Msida, Malta
| | - Mark Gruppetta
- Department of Endocrinology and General Medicine, Mater Dei Hospital, Msida, Malta
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3
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Wang Z, Liu F, Li C, Yuan H, Xiang Y, Wei C, Zhu D, Wang M. Case Report: Octreotide plus CVD chemotherapy for the treatment of multiple metastatic paragangliomas after double resection for functional bladder paraganglioma and urothelial papilloma. Front Oncol 2023; 12:1072361. [PMID: 36741690 PMCID: PMC9895770 DOI: 10.3389/fonc.2022.1072361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/28/2022] [Indexed: 01/22/2023] Open
Abstract
Background Metastatic pheochromocytomas and paragangliomas are rare neuroendocrine tumors with a poor prognosis. Bladder paraganglioma concomitant with urothelial papilloma is even rarer. However, the rate of tumor response to cyclophosphamide-vincristine-dacarbazine (CVD) chemotherapy and 5-year overall survival for patients with metastatic PPGLs remained lower. We described, for the first time, a case of a patient with multiple metastatic bladder PGL who received octreotide LAR combined with CVD chemotherapy after urological surgery and then octreotide therapy was continued during follow-up. Case presentation A 43-year-old male patient was admitted to the urology department for frequent micturition syncope concomitant with malignant hypertension. Preoperative findings were elevated levels of normetanephrine in 24-h urine or plasma. CT and MRI indicated diagnosis of suspicious bladder paraganglioma. Transurethral resection of bladder tumor combined with laparoscopic partial cystectomy was performed successfully after preoperative phenoxybenzamine with aggressive volume repletion for 7 days. The result of postoperative pathology was immediate-risk functional bladder paraganglioma (T2N0M0, Stage II) concomitant with urothelial papilloma, and the immunohistochemistry results of PPGL were positive for Ki-67 (15%), SDHB, CgA, and SSTR2. The patient achieved enhanced recovery with normal urination and no syncope after surgery. However, the results of 18F-FDG and 18F-DOTATATE PET/CT found that the metastatic localizations of bladder PGLs were in the liver, lung, and bones at the 8th month after surgery. The patient received octreotide long-acting repeatable plus six courses of CVD chemotherapy for 6 months, and then octreotide therapy was continued every 3 months until now. Metastatic localizations were stable in CT scans, and vanillylmandelic acid in 24-h urine was maintained at lower levels during follow-up. Conclusion Octreotide long-acting repeatable plus CVD chemotherapy after surgery could achieve stable disease in the case with multiple metastatic bladder PGLs, and the following octreotide therapy could maintain a state of stable disease during the period of 6-month follow-up.
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Affiliation(s)
- Zilong Wang
- Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China,Department of Urology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Feifan Liu
- Department of Urology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chao Li
- Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Huisheng Yuan
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yuzhu Xiang
- Department of Urology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China,Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chunxiao Wei
- Department of Urology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China,Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Dongyuan Zhu
- Rare Tumors Department, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China,*Correspondence: Muwen Wang, ; Dongyuan Zhu,
| | - Muwen Wang
- Department of Urology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China,Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China,*Correspondence: Muwen Wang, ; Dongyuan Zhu,
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Non-functional bladder paraganglioma in a patient with complex hematological disorders: case report. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00308-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although bladder cancer is quite a common cancer, most common encounter being transitional cell carcinomas, paragangliomas with such localization, is a very rare histopathological finding. In addition, hematuria in a patient with a theoretically "hypercoagulable" condition is uncommon; in our case it was the single symptom.
Case presentation
We report the case of a 44-year-old female referred to our hospital for gross hematuria. The CT scan revealed an intraluminal enhancing bladder mass. Also, the XIII coagulation factor level was 36% and surprisingly genetic mutations suggesting inherited thrombophilia were found: MTHFR C677T negative, A1298C positive and PAI-1 gene polymorphism (675 4G/5G). The hematologist recommended folic acid 5 mgs daily. A TURBT was performed (macroscopically no residual tumor tissue). The immunohistochemical examination revealed tumor cells intensely positive to chromogranin and synaptophysin, negative for cytokeratin AE1/3, p63, 7, 20 or CDX2, and slight (less than 5%) positive for Ki-67. The combined examinations correspond to a bladder paraganglioma. Six months after surgery, the patient had no clinical symptoms and no relapse sonographically and cystoscopically.
Conclusions
Although a very rare entity, bladder paraganglioma should be suspected in patients with hematuria and unexplained hyperadrenalism symptoms such as hypertension, serious dizziness, headache or palpitation. The immunohistochemical examination is important not only for diagnosis but also for identifying the functionality of the tumors. In such cases the therapeutic management could be different as in transitional cell carcinomas.
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Matsuzawa N, Nishikawa T, Ohno R, Inoue M, Nishimura Y, Okamoto T, Shimizu T, Shinagawa T, Nishizawa Y, Kazama S. Paraganglioma of the urinary bladder initially diagnosed as gastrointestinal stromal tumor requiring combined resection of the rectum: a case report. World J Surg Oncol 2022; 20:185. [PMID: 35676716 PMCID: PMC9178902 DOI: 10.1186/s12957-022-02662-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Paraganglioma of the urinary bladder (Pub) is rare and presents with clinical symptoms caused by catecholamine production and release. The typical symptoms of Pub are hypertension, macroscopic hematuria, and a hypertensive crisis during micturition. The average size of detected Pubs is approximately 3 cm. Herein, we report a case of a large Pub in which the symptoms were masked by oral medication, precise preoperative diagnosis was difficult, and intraoperative confirmation of tumoral adhesion to the rectum resulted in hypertensive attacks during surgery. Case presentation A 64-year-old Japanese male with a history of hypertension and arrhythmia controlled with oral medication presented with a large tumor in the pelvic region, detected on examination for weight loss, with no clinical symptoms. Computed tomography and magnetic resonance imaging revealed a tumor measuring 77 mm in diameter in the posterior wall of the urinary bladder. The border with the rectum was unclear, and the tumor showed heterogeneous enhancement in the solid part with an enhancing hypodense lesion. Cystoscopy revealed compression of the bladder trigone by external masses; however, no tumor was visible in the lumen. Endoscopic ultrasonography-guided fine-needle aspiration revealed CD34-positive spindle-shaped cells in the fibrous tissue, suggestive of a mesenchymal neoplasm. The tumor was suspected to be a gastrointestinal stromal tumor, and surgery was performed. After laparotomy, we suspected that the tumor had invaded the rectum, and total cystectomy and anterior resection of the rectum were performed. Histologically, the tumor cells had granular or clear amphophilic cytoplasm with an oval nucleus and nests of cells delimited by connective tissue and vascular septations. Immunohistochemically, the tumor was positive for chromogranin A, CD56, and synaptophysin, and a diagnosis of paraganglioma of the urinary bladder was confirmed. There was no tumor recurrence at the 7-month follow-up. Conclusion This case highlights the importance of careful examination of pelvic tumors, including endocrine testing, for detecting paraganglioma of the urinary bladder in patients with a history of hypertension or arrhythmia.
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Affiliation(s)
- Natsumi Matsuzawa
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan.
| | - Takeshi Nishikawa
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Riki Ohno
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Masaharu Inoue
- Department of Urology, Saitama Cancer Center, Saitama, Japan
| | - Yu Nishimura
- Department of Pathology, Saitama Cancer Center, Saitama, Japan
| | - Tomomi Okamoto
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Takao Shimizu
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Takahide Shinagawa
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Yusuke Nishizawa
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Shinsuke Kazama
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, 362-0806, Japan
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6
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Yuan Y, Su Z, Zhu R, Li X, Xu G. Bladder Paraganglioma: Three Cases Report and Literature Review. Int Med Case Rep J 2021; 14:765-771. [PMID: 34803407 PMCID: PMC8594893 DOI: 10.2147/imcrj.s336659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/16/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Bladder paraganglioma (BPG) is one of the rare neuroendocrine neoplasms that develops from neural crest cells. It categorizes into functional and non-functional types based on the catecholamines secretion. Currently, functional BPG is predicted in advance based on signs and symptoms of catecholamine excess, such as hypertension and "micturition attacks". However, it is often overlooked because of its rareness. Misdiagnosis of a functional tumor may increase the risk of surgical intervention. CASE PRESENTATION We reported 3 cases of BPG that they were admitted to the hospital due to abdominal pain or gross hematuria. Computed tomography (CT) scans showed space-occupying lesions in the bladders with diameters less than 3cm. There were no typical catecholamine excess symptoms before surgical intervention. Postoperative pathology confirmed BPG after removal of the tumor. We also analyze 69 cases of BPG that has been reported and found that 78.0% cases were functional among the tumors larger than 3cm. CONCLUSION Bladder tumors larger than 3cm in diameter can serve as an additional predictor of functional BPG. Patients who are suspected should undergo magnetic resonance imaging (MRI) scans, 123/131 metaiodobenzylguanidine (MIBG) scan, and have their catecholamine levels tested. Once the diagnosis is confirmed, patients should be started on fluid replacement therapy and adrenergic blockade to abate the disorders associated with catecholamine excess.
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Affiliation(s)
- Yaoji Yuan
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
- Key Laboratory of Enhanced Recovery After Abdominal Surgery, Guangzhou, Guangdong, People’s Republic of China
| | - Zhengming Su
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
- Key Laboratory of Enhanced Recovery After Abdominal Surgery, Guangzhou, Guangdong, People’s Republic of China
| | - Rui Zhu
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
- Key Laboratory of Enhanced Recovery After Abdominal Surgery, Guangzhou, Guangdong, People’s Republic of China
| | - Xiezhao Li
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
- Key Laboratory of Enhanced Recovery After Abdominal Surgery, Guangzhou, Guangdong, People’s Republic of China
| | - Guibin Xu
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
- Key Laboratory of Enhanced Recovery After Abdominal Surgery, Guangzhou, Guangdong, People’s Republic of China
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7
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Muhammad S, Yousaf A, Qayyum A, Nazim R, Taqi M. Paraganglioma of Urinary Bladder in a Pediatric Patient. Cureus 2021; 13:e13964. [PMID: 33880298 PMCID: PMC8052522 DOI: 10.7759/cureus.13964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Paragangliomas arise from neural cells and are found in different anatomical locations in the body. Paragangliomas in the adrenal glands are called pheochromocytoma, while the others are known as extra-adrenal paragangliomas. They are usually benign and are extremely rare in children. We present a case of a 13-year-old female patient who presented with complaints of hematuria for one year and left lower lumbar pain. Imaging investigations depicted a urinary bladder mass that was causing a mass effect at the left ureteric opening and backpressure changes in the left kidney. The patient underwent transurethral resection of bladder mass, and the histopathology confirmed the presence of paraganglioma. Though the paragangliomas of the urinary bladder are extremely rare in the pediatric age group, we suggest keeping paragangliomas on differentials when investigating a patient with bladder mass.
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Affiliation(s)
- Shoaib Muhammad
- Department of Urology, Ghulab Devi Hospital, Al-Aleem Medical College, Lahore, PAK
| | - Amman Yousaf
- Department of Radiology, Hamad General Hospital, Doha, QAT.,Department of Radiology, Services Hospital Lahore, Lahore, PAK
| | - Arif Qayyum
- Department of Urology, Ghulab Devi Hospital, Al-Aleem Medical College, Lahore, PAK
| | - Rabia Nazim
- Department of Community Medicine, King Edward Medical University, Lahore, PAK
| | - Muhammad Taqi
- Department of Anaesthesiology, Ghulab Devi Hospital, Al-Aleem Medical College, Lahore, PAK
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8
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Sunil V N, John K, Nawahirsha S, Iyyadurai R. Micturition syncope: a rare presentation of bladder paraganglioma. BMJ Case Rep 2020; 13:13/9/e235353. [PMID: 32878856 DOI: 10.1136/bcr-2020-235353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 68-year-old woman presented with episodes of headache, palpitations, sweating and poorly controlled hypertension for the past 6 years. These symptoms were, at times, associated with micturition, and there were few episodes of micturition syncope as well. She had elevated 24-hour urinary normetanephrine and was found to have a paraganglioma arising from the urinary bladder infiltrating the sigmoid colon. She underwent laparotomy with excision of the bladder paraganglioma, following which her symptoms subsided. Paragangliomas are extra-adrenal catecholamine-producing tumours. Bladder paragangliomas need to be considered when evaluating hypertensive patients with headache, palpitations or syncope related to micturition.
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Affiliation(s)
- Neethu Sunil V
- Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kevin John
- Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sultan Nawahirsha
- Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Iyyadurai
- Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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9
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Wang EY, Pak JS, Virk RK, Anderson CB, Healy KA, Lee JA, Benson MC, McKiernan JM. Bladder Preservation for Patients With Bladder Paragangliomas: Case Series and Review of the Literature. Urology 2020; 143:194-205. [PMID: 32437773 DOI: 10.1016/j.urology.2020.04.098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 12/27/2022]
Abstract
Bladder paragangliomas are rare tumors, with no prospective studies or guidelines on the management of this disease. We present a case series of 6 patients managed with bladder preservation over a median follow-up period of 124 months. We also present a review of the recent literature on bladder paragangliomas. We aim to provide a timely synthesis of the recent evidence on bladder paragangliomas as changing paradigms necessitate individualized treatment.
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Affiliation(s)
- Elizabeth Y Wang
- Department of Urology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY; Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
| | - Jamie S Pak
- Department of Urology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Renu K Virk
- Department of Pathology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Christopher B Anderson
- Department of Urology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Kelly A Healy
- Department of Urology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - James A Lee
- Department of Surgery, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Mitchell C Benson
- Department of Urology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - James M McKiernan
- Department of Urology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
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10
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Teragaki M, Yamamoto T, Hosomi K, Tada Y, Maeda K, Nishiya D, Miyazaki C, Takagi Y, Sakanoue Y, Nishida Y, Okuno H, Tsuiki M, Naruse M. Miction-induced Hypertension Disclosed by Home Blood Pressure Measurement in a Patient with Small Paraganglioma. Intern Med 2020; 59:793-797. [PMID: 31813909 PMCID: PMC7118378 DOI: 10.2169/internalmedicine.3255-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 46-year-old woman complained of a 10-year history of headache, nausea, a precordial oppressive feeling and shortness of breath on miction. She had noted a marked elevation in her blood pressure after miction using home blood pressure measurement. Her catecholamine levels were less than twice the value of the normal upper limit. Several imaging modalities detected a urinary bladder tumor, and 123I-metaiodobenzylguanidine scintigraphy showed positive accumulation. The diagnosis of urinary bladder paraganglioma was confirmed by partial cystectomy. We must keep in mind that paroxysms and hypertension associated with miction are important diagnostic clues of pheochromocytoma/paraganglioma. Home blood pressure measurement was very useful for detecting hypertension in this case.
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Affiliation(s)
| | | | - Kota Hosomi
- Department of Cardiology, Higashisumiyoshi Morimoto Hospital, Japan
| | - Youhei Tada
- Department of Cardiology, Higashisumiyoshi Morimoto Hospital, Japan
| | - Keiko Maeda
- Department of Cardiology, Higashisumiyoshi Morimoto Hospital, Japan
| | - Daisuke Nishiya
- Department of Cardiology, Higashisumiyoshi Morimoto Hospital, Japan
| | - Chinami Miyazaki
- Department of Cardiology, Higashisumiyoshi Morimoto Hospital, Japan
| | - Yasuhiro Takagi
- Department of Cardiology, Higashisumiyoshi Morimoto Hospital, Japan
| | - Yuji Sakanoue
- Department of Cardiology, Higashisumiyoshi Morimoto Hospital, Japan
| | - Yukio Nishida
- High Care Unit, Higashisumiyoshi Morimoto Hospital, Japan
| | - Hiroshi Okuno
- Department of Urology, National Hospital Organization Kyoto Medical Center, Japan
| | - Mika Tsuiki
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
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11
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Zhang B, Fu Z, Liu L, Qiao B, Liu C. Non-functional paraganglioma of urinary bladder managed by transurethral resection. Int Braz J Urol 2019; 45:910-915. [PMID: 31038858 PMCID: PMC6844347 DOI: 10.1590/s1677-5538.ibju.2018.0604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/30/2019] [Indexed: 01/17/2023] Open
Abstract
Purpose As a rare bladder tumor, paraganglioma of the urinary bladder (PUB) is frequently misdiagnosed as bladder cancer, particularly for the non-functional type. To date, transurethral resection remains a controversial treatment for non-functional PUB. This study aimed to identify the clinical features, pathological characteristics, prognosis, and safe/effective treatment of non-functional PUB using transurethral resection of the bladder tumor (TURBT). Materials and Methods The clinical records, radiological data, pathological characteristics and follow-up times were retrospectively reviewed in 10 patients with clinically and pathologically proven non-functional PUB in our hospital from January 2008 to November 2016. All patients underwent TURBT treatment. Results The incidence of non-functional PUB in patients with bladder cancer was 0.17%. The mean age at diagnosis was 44.5 ± 13.6 years (range, 29-70 years), and the patient population had a female: male ratio of 3: 2. No patients had excess catecholamine (CA) whilst four patients had painless hematuria. All neoplasms were completely resected via TURBT. The majority of samples were positive for immunohistochemical markers including chromogranin A (CgA) and Synaptophysin (Syn), but were negative for cytokeratins (CKs). Only a single recurrence was observed from the mean follow-up period of 36.4 ± 24.8 months. Conclusion Complete TURBT is a safe and efficient treatment that serves both diagnostic and therapeutic purposes. Histopathological and immunohistochemistry examinations are mandatory for diagnostic confirmation. Long-term follow-up is recommended for patients with non-functional PUB.
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Affiliation(s)
- Baochao Zhang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhenrui Fu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Liwei Liu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Baomin Qiao
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Chunyu Liu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
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12
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Kaur S, Gupta A, Gulwani HV. A clinicopathological and immunohistochemical study of non-urothelial bladder tumours. Indian J Cancer 2019; 56:254-260. [PMID: 31389390 DOI: 10.4103/ijc.ijc_459_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Non-urothelial bladder tumors (NUBTs) are uncommon accounting for approximately 10% of the total urinary bladder tumors while 90% are urothelial in origin. There are very limited comprehensive studies on NUBTs. AIMS AND OBJECTIVES The objectives of the study were to analyze the clinicopathological and immunohistochemical features of NUBTs. MATERIALS AND METHODS This is a retrospective study of NUBTs diagnosed over a period of 9 years. Patients' files were retrieved from the archives. Gross and microscopic features were recorded. Simple percentage and frequencies were used to interpret the data. RESULTS A total 16 cases (10.8% of all bladder tumors) of NUBT were found. Patients' ages ranged from 19 to 87 years with a male: female ratio of 4.3:1. The most common presenting symptom was gross hematuria (81.2%), and the most common location was posterolateral bladder wall. Muscle invasion was seen in 81.2% of cases, and large areas of necrosis were observed in 62.5%. There were two cases of squamous cell carcinoma, five cases each of adenocarcinoma (four secondary and one urachal) and mesenchymal tumors (four malignant and one benign), two cases of amyloid, and one case each of plasmacytomas and paraganglioma. Large areas of necrosis and muscle invasion were noted in high-grade and advanced staged tumors. In all, 43.7% had poor survival. CONCLUSION NUBTs present with similar clinicoradiological findings; however, their histological features along with immunohistochemistry help in the definite diagnosis. One should be aware of these tumors as they frequently present diagnostic and therapeutic challenge. Most of these neoplasms present at an advanced stage. Large or multicentric randomized controlled studies are needed to know the exact behavior and prognosis of these tumors.
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Affiliation(s)
- Sukhpreet Kaur
- Department of Pathology, Bhopal Memorial Hospital and Research Centre (Under Department of Health Research), Bhopal, Madhya Pradesh, India
| | - Avinash Gupta
- Department of Pathology, Bhopal Memorial Hospital and Research Centre (Under Department of Health Research), Bhopal, Madhya Pradesh, India
| | - Hanni V Gulwani
- Department of Pathology, Bhopal Memorial Hospital and Research Centre (Under Department of Health Research), Bhopal, Madhya Pradesh, India
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Lu H, Male M, Jiang K, Ye Z, Song D, Xia D. Clinical significance of functional and anatomical classifications in paraganglioma of the urinary bladder. Urol Oncol 2019; 37:354.e9-354.e17. [PMID: 30799087 DOI: 10.1016/j.urolonc.2019.01.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Paragangliomas of the urinary bladder (PUBs) are challenging catecholamine-producing neuroendocrine tumors. We aimed to facilitate their diagnosis and treatment by functional and anatomical classifications. MATERIALS AND METHODS Between April 2007 and September 2017, 31 cases from 2 centers were retrieved, in which the patients were pathologically diagnosed with PUB. Besides classifying them into functional and nonfunctional PUBs, functional PUBs were further subclassified into typical functional PUB (with typical symptoms and elevated catecholamines/metabolites levels) and atypical functional PUB. Anatomically, they were classified into submucosal, intramural, and subserosal PUBs. RESULTS Functionally, these cases comprised 17 (54.8%) functional and 14 (45.2%) nonfunctional PUBs. Functional PUBs had significantly larger diameters than nonfunctional PUBs (P < 0.01). Of the 17 functional PUB cases, 8 were further subclassified into typical functional PUB, of which 4 were diagnosed without cystoscopy. Anatomically, these cases comprised 14 (45.2%) submucosal, 13 (41.9%) intramural, and 4 (12.9%) subserosal PUBs. Intramural and subserosal PUBs had significantly larger diameters and were more likely to be functional than submucosal PUBs (P < 0.05). Cystoscopy failed to detect the tumor in all patients with subserosal PUB. Besides all patients with intramural or subserosal PUB, 1 patient with submucosal PUB underwent partial cystectomy. The remaining 13 patients with submucosal PUB underwent transurethral resection of bladder tumor, 5 of whom required extra surgical intervention. CONCLUSIONS By functional classification, omitting cystoscopy is feasible in the diagnosis of typical functional PUBs. By anatomical classification, intramural, and subserosal PUBs tend to be large and functional. Moreover, negative cystoscopic findings are not sufficient to exclude subserosal PUBs. Finally, not all submucosal PUBs are amenable to transurethral resection of bladder tumor.
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Affiliation(s)
- Hongyan Lu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Institute of Urology, Wuhan, China; Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Musa Male
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Institute of Urology, Wuhan, China
| | - Kehua Jiang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Institute of Urology, Wuhan, China
| | - Dongkui Song
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Ding Xia
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Zhai H, Ma X, Nie W, Li H, Peng C, Li X, Zhang Y, Zhang X. Paraganglioma of the Urinary Bladder: A Series of 22 Cases in a Single Center. Clin Genitourin Cancer 2017; 15:e765-e771. [PMID: 28688872 DOI: 10.1016/j.clgc.2017.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/18/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Paraganglioma of the urinary bladder (PUB) is rare in bladder cancer, and currently, a study examining large number of cases from a single center has not been reported. This study aimed to present the clinical features, treatments, pathological characteristics, and prognosis of PUB. PATIENTS AND METHODS From January 2006 to June 2016, 22 patients were pathologically diagnosed with PUB in our hospital. Their clinical records, operative notes, pathological reports, and follow-up records were retrospectively reviewed. RESULTS The incidence of PUB in patients with bladder cancer was 0.92%. The mean age at diagnosis was 49.8 ± 14.6 years (range, 16-76 years) and the male to female ratio was 1:1. Fourteen cases (63.6%) were functional. The common indicative symptoms included hematuria (36.4%), hypertension (31.8%), micturition syncope (27.3%), headache (18.2%), and palpitation (13.6%). All neoplasms were completely resected via transurethral resection of bladder tumor (TURBT), en bloc transurethral resection with thulium-yag laser, or partial cystectomy. Most PUB samples were positive for immunohistochemical (IHC) staining markers such as chromogranin A (CgA), Synaptophysin (Syn), CD56, and S-100 protein, while negative for IHC markers such as cytokeratins (CKs) and Melan A. According to pathological reports, 72.7% of PUB cases were at stage T2, 18.2% at T3, and 9.1% at T4. Two cases (9.1%) with metastasis were malignant. Two patients (9.1%) were lost during follow-up, and the remaining 20 patients were followed up for a period of 67.8 ± 38.5 months (range, 6-130 months). Among them, 16 patients (80%) recovered after the surgery, 1 patient (5%) died of natural causes. PUB recurred in 3 patients (15%), and 1 patient among them died of PUB. CONCLUSION Despite the rarity, PUB should be suspected in patients with unexplained symptoms such as micturition syncope, hematuria, hypertension, headache, or palpitation. Surgery and adjuvant therapies are effective treatments for PUB. Compared with open surgery, laparoscopic partial cystectomy and robot-assisted laparoscopic partial cystectomy are advantageous in the treatment of PUB. Long-term follow-up is recommended for patients with PUB.
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Affiliation(s)
- Hongyun Zhai
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Xin Ma
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Wenyuan Nie
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Hongzhao Li
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Cheng Peng
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Xintao Li
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Yu Zhang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China
| | - Xu Zhang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, P.R. China.
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15
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Abstract
Urinary bladder paraganglioma constitute only a small fraction of urinary bladder tumors. These rare tumors are well known for recurrences even after many years of surgery. Functional imaging with different radiotracers has been found to be useful to evaluate the extent, metastasis, and recurrence of paragangliomas. We report a case where Ga DOTANOC PET/CT successfully detected recurrence of a paraganglioma in the urinary bladder along with pelvic lymph nodal metastasis.
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Katiyar R, Dwivedi S, Trivedi S, Patne SCU, Dwivedi US. Non-Functional Paraganglioma of the Urinary Bladder Treated by Transurethral Resection: Report of Two Cases. J Clin Diagn Res 2016; 10:XD01-XD03. [PMID: 27042569 DOI: 10.7860/jcdr/2016/17953.7219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/05/2016] [Indexed: 11/24/2022]
Abstract
Paraganglioma of the urinary bladder is a rare tumour derived from chromaffin tissue of the sympathetic nervous system. Paraganglioma of the urinary bladder especially the non-functional type is often misdiagnosed as urothelial cancer. Two female patients aged 32 years and 45 years presented with painless haematuria without any symptoms of catecholamine excess. Radiological investigations revealed urinary bladder tumour. The tumour was removed by transurethral resection in both the patients. Histopathological diagnosis was paraganglioma, which was confirmed by immunohistochemistry. Complete resection of tumour by transurethral approach is curative in paraganglioma of the urinary bladder. We hereby, also discuss the salient features of nonfunctional paraganglioma of the urinary bladder.
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Affiliation(s)
- Richa Katiyar
- Service Senior Resident, Department of Pathology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, (U.P.), India
| | - Saloni Dwivedi
- Junior Resident, Department of Pathology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, (U.P.), India
| | - Sameer Trivedi
- Associate Professor, Department of Urology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, (U.P.), India
| | - Shashikant C U Patne
- Assistant Professor, Department of Pathology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, (U.P.), India
| | - Uday Shankar Dwivedi
- Professor and Head, Department of Urology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, (U.P.), India
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17
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Chang YK, Chiang IN, Chen CH, Wang SM, Lee YJ, Pu YS, Huang CY. Paragangliomas of the urinary bladder: A report of 6 cases and review of the literature. UROLOGICAL SCIENCE 2015. [DOI: 10.1016/j.urols.2015.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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18
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Bagchi A, Dushaj K, Shrestha A, Leytin AL, Bhuiyan SA, Radparvar F, Topchik S, Tuli SS, Kim P, Bakshi S. Urinary bladder paraganglioma presenting as micturition-induced palpitations, dyspnea, and angina. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:283-6. [PMID: 25965060 PMCID: PMC4444169 DOI: 10.12659/ajcr.891388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sympathetic urinary bladder paragangliomas are rare catecholamine-secreting neuroendocrine tumors arising from neural crest cells. They are uncommon urinary bladder neoplasms. Symptoms classically include micturition-related or unrelated palpitations and syncope with hypertension, headaches, diaphoresis, and hematuria. Other than being attributable to vasovagal reactions, micturition-induced cardiovascular symptoms should prompt a search for catecholamine-secreting tumors such as a urinary bladder paraganglioma, as in this case. CASE REPORT A 45-year-old asthmatic African-American female presented with episodic hematuria that began 4 years ago and episodes of micturition-induced palpitations, dyspnea, substernal tightness, sweating, and throbbing headaches. Computed tomography with contrast revealed an enhancing mass along the anterior urinary bladder wall, measuring 2.4×3.5 cm. On Positron emission Tomography with [18F] fluorodeoxyglucose integrated with computed tomography (18F-FDG PET/CT), the urinary bladder mass was 18F-FDG avid. Serum normetanephrine and supine plasma norepinephrine were significantly elevated and there was mild elevation of supine plasma epinephrine. Transurethral resection of the bladder mass revealed a neoplasm with microscopic features and immunohistochemical profile positive for synaptophysin and chromogranin, with negative screening cytokeratin AE1/AE3, suggesting a paraganglioma. Following resection of the paraganglioma, there was complete resolution of micturition-induced cardiovascular symptoms on long-term follow-up. CONCLUSIONS Micturition-related cardiovascular symptoms are commonly attributed to vasovagal reactions. However, urinary bladder pathologies must be ruled out as a cause, as in this rare case of a urinary bladder paraganglioma exhibiting catecholaminergic symptoms.
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Affiliation(s)
- Arindam Bagchi
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Kola Dushaj
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Anup Shrestha
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Anatoly L Leytin
- Department of Pathology, Icahn School of Medicine at Mount Sinai/Elmhurst Hospital Center, Elmhurst, NY, USA
| | - Shamsul A Bhuiyan
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Farshid Radparvar
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, USA
| | - Shlomo Topchik
- Department of Nuclear Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Sandeep Singh Tuli
- Department of Radiology, Ichan School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Paul Kim
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
| | - Sanjiv Bakshi
- Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA
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19
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Wong EMH, Lai TCT, Tsu JHL, Yee CH, Fan CW, Cheung FK, Ng CF, Yiu MK. Primary paraganglioma of urinary bladder: Case series and review of the literature. SURGICAL PRACTICE 2015. [DOI: 10.1111/1744-1633.12069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Chi-Hang Yee
- Department of Surgery; Chinese University of Hong Kong; Hong Kong
| | - Chi-Wai Fan
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong
| | - Fu-Keung Cheung
- Department of Surgery; Princess Margaret Hospital; Hong Kong
| | - Chi-Fai Ng
- Department of Surgery; Chinese University of Hong Kong; Hong Kong
| | - Ming-Kwong Yiu
- Department of Surgery; University of Hong Kong; Hong Kong
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20
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Martucci VL, Lorenzo ZG, Weintraub M, del Rivero J, Ling A, Merino M, Siddiqui M, Shuch B, Vourganti S, Linehan WM, Agarwal PK, Pacak K. Association of urinary bladder paragangliomas with germline mutations in the SDHB and VHL genes. Urol Oncol 2015; 33:167.e13-20. [PMID: 25683602 DOI: 10.1016/j.urolonc.2014.11.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 11/02/2014] [Accepted: 11/26/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our primary goal was to examine the clinical characteristics of a series of patients with urinary bladder paragangliomas (UBPGLs), focusing particularly on their genetic backgrounds. MATERIALS AND METHODS We analyzed the medical records of patients who presented to the National Institutes of Health with UBPGL from 2000 to 2013 to determine their clinical characteristics and outcomes, biochemical phenotype, tumor size, and genetic background. RESULTS Of the 27 patients with UBPGLs who were identified, 17 (63%) had underlying genetic mutations. Overall, 14 (51.9%) patients had a germline mutation in the succinate dehydrogenase subunit B gene (SDHB), and 3 (11.1%) had mutations in the von Hippel-Lindau gene (VHL). Of the 21 patients who had biochemical data available before their first operation, 19 (90.5%) presented with a noradrenergic biochemical phenotype; 7 (33.3%) patients had tumors that also secreted dopamine. In addition, 1 patient (4.8%) had elevated metanephrine levels, and 2 (9.5%) had normal biochemical data. In total, 13 (48.1%) patients in the series were diagnosed with metastatic disease, at either first presentation or follow-up; 6 of these patients (46.1%) had SDHB mutations. CONCLUSIONS UBPGLs typically present with a noradrenergic phenotype and are frequently associated with underlying germline mutations. Patients presenting with these rare neuroendocrine tumors should be screened for these mutations. In addition, patients with UBPGLs should be followed up closely for metastatic development regardless of genetic background, as almost half of the patients in this series presented with metastatic disease and less than half of them had SDHB mutations.
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Affiliation(s)
- Victoria L Martucci
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Zarina G Lorenzo
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; Section of Endocrinology and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines
| | | | - Jaydira del Rivero
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Alexander Ling
- Radiology and Imaging Sciences Department, Warren Magnuson Clinical Center, National Institutes of Health, Bethesda, MD
| | - Maria Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Minhaj Siddiqui
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD
| | - Brian Shuch
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD
| | | | | | - Piyush K Agarwal
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD.
| | - Karel Pacak
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
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21
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Ranaweera M, Chung E. Bladder paraganglioma: A report of case series and critical review of current literature. World J Clin Cases 2014; 2:591-595. [PMID: 25325073 PMCID: PMC4198415 DOI: 10.12998/wjcc.v2.i10.591] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/02/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023] Open
Abstract
Extra-adrenal chromaffin cell-related tumours or paragangliomas are rare, especially in the bladder. In this article, we reported three different clinical cases of bladder paraganglioma, followed by a review of current literature on the pathophysiology and management of bladder paraganglioma. Case 1 involved a 23 years old female patient who complained of a 10-year history of micturition-related headaches, palpitations and diaphoresis; while in case 2, a 58 years old female patient presented with history of painless haematuria and an incidentally diagnosis of a functioning paraganglioma during endoscopic transurethral resection of bladder tumour; and lastly in case 3, a 54 years old male renal transplant recipient was referred to the urology outpatient with a suspicious bladder mass found incidentally on routine transplant workshop.
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22
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Hodin R, Lubitz C, Phitayakorn R, Stephen A. Diagnosis and management of pheochromocytoma. Curr Probl Surg 2014; 51:151-87. [DOI: 10.1067/j.cpsurg.2013.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/27/2013] [Indexed: 12/21/2022]
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Li Y, Guo A, Tang J, Li Q, Fei X, Zhang Y, Gao J. Evaluation of sonographic features for patients with urinary bladder paraganglioma: a comparison with patients with urothelial carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:478-484. [PMID: 24412175 DOI: 10.1016/j.ultrasmedbio.2013.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 10/13/2013] [Accepted: 10/15/2013] [Indexed: 06/03/2023]
Abstract
The goals of the work described here were to analyze the ultrasonographic characteristics of urinary bladder paraganglioma and to evaluate the use of ultrasonography (US) in diagnosis. Ten patients with bladder paraganglioma (3 males, 7 females) and 51 patients with urothelial carcinoma (37 males, 14 females) were enrolled. Ultrasonographic characteristics as well as clinical features were analyzed. Patients with urothelial carcinoma were significantly older than those with paraganglioma (62.9 y vs. 48.1 y, p = 0.001). The patients with paraganglioma had higher average systolic blood pressure than those with urothelial carcinoma (146.7 mm Hg vs. 130.7 mm Hg, p = 0.012). All bladder paragangliomas were solitary, and 40% were located on the dome. There was a statistically significant difference in location of lesions between the bladder paraganglioma and urothelial carcinoma groups (p = 0.014). The longest diameters in 80% of the bladder paragangliomas were in the range 1.1-3.0 cm; 60% were hypoechoic, and 40% were located in the submucosa of the bladder. Color Doppler revealed that 40% of the bladder paragangliomas were highly vascular. One patient with paraganglioma and four patients with urothelial carcinoma underwent contrast-enhanced ultrasound, which revealed rapid contrast enhancement and slow wash-out, with a non-enhanced area. Contrast-enhanced ultrasound of urothelial carcinomas revealed rapid homogeneous enhancement and variable wash-out patterns. Pre-operative ultrasonography detected all neoplasms of the urinary bladder in the 10 patients with pathologically confirmed paraganglioma, but made the correct diagnosis in only 2 cases (20%). Although there is overlap in US findings among different diseases, solitary, submucosal masses arising on the dome may be the key US imaging characteristic for bladder paraganglioma.
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Affiliation(s)
- Yanmi Li
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Aitao Guo
- Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Jie Tang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
| | - Qiuyang Li
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Xiang Fei
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Yan Zhang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Jiangping Gao
- Department of Urology, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
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24
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Beilan JA, Lawton A, Hajdenberg J, Rosser CJ. Pheochromocytoma of the urinary bladder: a systematic review of the contemporary literature. BMC Urol 2013; 13:22. [PMID: 23627260 PMCID: PMC3654956 DOI: 10.1186/1471-2490-13-22] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 04/25/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pheochromocytoma (paraganglioma) of the urinary bladder is a rare tumor. Herein we sought to review the contemporary literature on pheochromocytomas of the urinary bladder in order to further illustrate the presentation, treatment options and outcomes of patients diagnosed with these tumors. METHODS A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed database and using the search terms "paraganglioma, pheochromocytoma, bladder." This search resulted in the identification of 186 articles published between January 1980 and April 2012 of which 80 articles were ultimately included in our analysis. RESULTS Pheochromocytomas usually occurred in young adult Caucasians (mean age, 43.3 years; range,11-84 years). According to the literature, the most common symptoms and signs of pheochromocytomas of the urinary bladder were hypertension, headache, and hematuria. Of the 77 cases that commented on catecholamine production, 65 patients had biochemically functional tumors. Approximately 20% of patients were treated by transurethral resection alone, 70% by partial cystectomy and 10% by radical cystectomy. The 75 patients with follow-up information had a mean follow-up of 35 months. At the time of last follow-up, 15 (14.2%) had disease recurrence, 10 (9.4%) had metastasis, and 65 (61.3%) were alive. CONCLUSIONS Pheochromocytomas of the urinary bladder tend to be functional and occur mostly in young adult Caucasians. Patients with localized tumors have an extremely favorable prognosis and may be managed by less aggressive modalities, whereas patients with metastatic disease have a significant reduction in survival rates despite aggressive treatment.
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Affiliation(s)
- Jonathan A Beilan
- Section of Urologic Oncology, MD Anderson Cancer Center Orlando, 1400 S. Orange Ave, Orlando, FL 32806, USA
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
| | - Adrienne Lawton
- Department of Pathology, Orlando Health/MD Anderson Cancer Center Orlando, Orlando, FL 32806, USA
| | - Julio Hajdenberg
- Section of Genitourinary Oncology, MD Anderson Cancer Center Orlando, Orlando, FL 32806, USA
| | - Charles J Rosser
- Section of Urologic Oncology, MD Anderson Cancer Center Orlando, 1400 S. Orange Ave, Orlando, FL 32806, USA
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
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25
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Christodoulidou M, Lucky M, Mansour P, Gammal M. Incidental paraganglioma of the urinary bladder in a 66-year-old woman. BMJ Case Rep 2013; 2013:bcr-2013-008771. [PMID: 23505281 DOI: 10.1136/bcr-2013-008771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 66-year-old female patient was referred to drology department when a bladder mass was incidentally found on a transvaginal ultrasound scan. Cystoscopy revealed a small, smooth mass just above the trigone which appeared to be covered with normal urothelium. The histology from this growth after transurethral resection revealed a paraganglioma of the bladder. We will discuss the management of this case and literature review of this finding in this study.
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