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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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Zulia Y, Gopireddy D, Virarkar MK, Morani AC, Adimula P, Kumar S, Bhosale P, Lall C. Magnetic resonance imaging of bladder pheochromocytomas: a review. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4032-4041. [PMID: 35347385 DOI: 10.1007/s00261-022-03483-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 01/18/2023]
Abstract
Bladder pheochromocytomas (PCCs) are rare tumors that account for 0.06% of all bladder tumors and makeup 1% of all PCCs. Most PCCs are functional, and they secrete catecholamines that lead to clinical symptoms such as paroxysmal hypertension, headaches, palpitations, and sweating. However, some are nonfunctional and asymptomatic and are hence difficult to diagnose. Cystoscopy and biopsy should not be performed when bladder PCCs are suspected. They may provoke a hypertensive crisis if preventative antiadrenergic blockers are not administered prior to the procedure. The diagnostic workup begins with obtaining blood or urine catecholamine and catecholamine metabolite values to make a presumptive diagnosis of bladder PCC. Computed tomography (C.T.) and magnetic resonance imaging (MRI) are then used to localize and stage the tumor for surgical resection. MRI, due to its superior soft tissue resolution and the ability to use multiparametric MRI (mpMRI) to differentiate between layers of the bladder wall and from other bladder masses, is the optimal imaging modality to detect extra-adrenal bladder PCCs and determine locoregional staging. Once antiadrenergic medications are given, the tumor is resected, and the diagnosis is confirmed histologically. However, the differential diagnosis of bladder PCC often gets overlooked, leading to surgical resection in the absence of antiadrenergic medications, increasing the chances of a fatal hypertensive crisis. This makes MRI an essential diagnostic tool for staging bladder PCCs before surgery. This review discusses the indications for MRI in bladder PCCs and describes findings from these tumors on various MRI sequences and when to use them. We also discuss how MRI can differentiate bladder PCCs from other bladder neoplasms.
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Affiliation(s)
- Yanni Zulia
- School of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine (LECOM), 5000 Lakewood Ranch Blvd, Bradenton, FL, 34211, USA.
| | - DheerajReddy Gopireddy
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Mayur K Virarkar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sindhu Kumar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Priya Bhosale
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
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4
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Kurose H, Ueda K, Uegaki M, Ogasawara N, Kumagae H, Chikui K, Nakiri M, Nishihara K, Matsuo M, Suekane S, Akiba J, Yano H, Igawa T. Paraganglioma of the urinary bladder: Case report and literature review. IJU Case Rep 2020; 3:192-195. [PMID: 32914072 PMCID: PMC7469756 DOI: 10.1002/iju5.12185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/02/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Paraganglioma of the urinary bladder is a very rare disease accounting for 0.06% of all bladder tumors. Owing to their rarity and symptomatic variability, preoperative diagnosis is often difficult. CASE PRESENTATION A 70-year-old male was referred to our department for hematuria. Cystoscopy showed a non-papillary broad-based tumor. Computed tomography and magnetic resonance imaging revealed a 32-mm bladder tumor at the top of the bladder, which suggested muscle-invasive bladder tumor. We diagnosed muscle-invasive bladder cancer or urachal carcinoma, and transurethral resection of the bladder tumor was performed. At the initiation of transurethral resection of the bladder tumor, the systolic blood pressure was elevated to over 200 mmHg. The pathological findings revealed paraganglioma of the urinary bladder, and afterward, a partial cystectomy was performed. CONCLUSION We herein reported the case of paraganglioma in the bladder whose blood pressure became extremely elevated during transurethral resection of the bladder tumor. In addition, we analyzed important factors for preoperative diagnosis using 162 cases reported in Japan.
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Affiliation(s)
- Hirofumi Kurose
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Kosuke Ueda
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Mami Uegaki
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Naoyuki Ogasawara
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Hisaji Kumagae
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Katsuaki Chikui
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Makoto Nakiri
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Kiyoaki Nishihara
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Mitsunori Matsuo
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Shigetaka Suekane
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Jun Akiba
- Department of Pathology Kurume University School of Medicine Kurume Japan
| | - Hirohisa Yano
- Department of Pathology Kurume University School of Medicine Kurume Japan
| | - Tsukasa Igawa
- Department of Urology Kurume University School of Medicine Kurume Japan
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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: 0.3] [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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Kido K, Hatakeyama S, Hamano I, Yamamoto H, Imai A, Yoneyama T, Hashimoto Y, Koie T, Fujita T, Murakami R, Tomita H, Suzuki T, Narumi S, Ohyama C. Partial Cystectomy of Paraganglioma of the Urinary Bladder Before Living Kidney Transplantation: Case Report. Transplant Proc 2018; 50:898-901. [PMID: 29661460 DOI: 10.1016/j.transproceed.2018.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/29/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Paraganglioma (extra-adrenal pheochromocytoma) of the bladder is a very rare disease, accounting for 0.06% of all bladder tumors. Optimal management of bladder paraganglioma before kidney transplantation is unknown. We report a case of partial cystectomy for urinary bladder paraganglioma before living kidney transplantation. CASE PRESENTATION A 59-year-old man with a 27-year history of hemodialysis was referred to our department for further examination of a bladder tumor detected during pre-transplantation testing. Cystoscopy revealed a submucosal tumor on the right side of the bladder. The patient experienced a hypertensive crisis during transurethral resection of the bladder tumor. Endocrinologic and pathologic examinations confirmed the diagnosis of paraganglioma in the urinary bladder. A partial cystectomy was performed before kidney transplantation. Nine months after partial cystectomy, the patient underwent AB0-incompatible living kidney transplantation from his spouse. No disease recurrence or graft rejection was observed 12 months after the transplantation. CONCLUSIONS To our knowledge, this is the 1st report on the management of paraganglioma in the urinary bladder before living kidney transplantation. Kidney transplantation after partial cystectomy is an option that may be considered in patients with paraganglioma of the urinary bladder, with careful observations of bladder function and vesicoureteral reflux to the grafts.
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Affiliation(s)
- K Kido
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - S Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - I Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - H Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - A Imai
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Y Hashimoto
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Fujita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - R Murakami
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - H Tomita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Suzuki
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - S Narumi
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - C Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Malhotra AK, Yan R, Tabeshi R, Nadel H, Tran H, Masterson J. Case - Bladder paraganglioma in a pediatric patient. Can Urol Assoc J 2018; 12:E260-E264. [PMID: 29405904 DOI: 10.5489/cuaj.4937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Armaan K Malhotra
- Faculty of Medicine, University of British Columbia; Vancouver, BC, Canada
| | - Ryan Yan
- Faculty of Medicine, University of British Columbia; Vancouver, BC, Canada
| | - Raymond Tabeshi
- British Columbia Children's Hospital, Department of Urological Sciences; Vancouver, BC, Canada
| | - Helen Nadel
- British Columbia Children's Hospital, Department of Nuclear Medicine; Vancouver, BC, Canada
| | - Henry Tran
- Faculty of Medicine, University of British Columbia; Vancouver, BC, Canada
| | - John Masterson
- British Columbia Children's Hospital, Department of Urological Sciences; Vancouver, BC, Canada
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Iwamoto G, Kawahara T, Tanabe M, Ninomiya S, Takamoto D, Mochizuki T, Kuroda S, Takeshima T, Izumi K, Hattori Y, Teranishi JI, Yumura Y, Miyoshi Y, Uemura H. Paraganglioma in the bladder: a case report. J Med Case Rep 2017; 11:306. [PMID: 29084607 PMCID: PMC5663097 DOI: 10.1186/s13256-017-1473-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/24/2017] [Indexed: 11/23/2022] Open
Abstract
Background Paraganglioma is an extra site of pheochromocytoma. Paraganglioma in the bladder is a very rare disease accounting for 0.06% of all bladder tumors. Case presentation A 77-year-old Japanese man was referred to our department for the further examination of a bladder tumor detected on preoperative computed tomography of his gastric cancer. Cystoscopy revealed a submucosal tumor in the upper area of his bladder, so transurethral resection of the bladder tumor was performed. During transurethral resection of the bladder tumor, his blood pressure sharply increased, and a pathological examination showed paraganglioma in his bladder. Postoperative I-123-metaiodobenzylguanidine scintigraphy detected a higher intake of his bladder tumor. Laboratory examinations showed a slightly increased noradrenaline level of 530 pg/ml and reduced platelet count at 167,000/μL. Based on the progression of his gastric cancer, no additional therapy was performed on his bladder tumor. Eight months after surgery, he died from aspiration pneumonitis. Conclusions Here we report a rare case of paraganglioma in the bladder. We discuss paraganglioma based on previous studies.
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Affiliation(s)
- Genta Iwamoto
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan.
| | - Mikiko Tanabe
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Sahoko Ninomiya
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Daiji Takamoto
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Taku Mochizuki
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shinnosuke Kuroda
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Teppei Takeshima
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Koji Izumi
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yusuke Hattori
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun-Ichi Teranishi
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Yumura
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasuhide Miyoshi
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroji Uemura
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
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9
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Srirangalingam U, Banerjee A, Patki P, Peters J, George E, Chew SL, Kumar VA, Korbonits M, Waterhouse M, Druce MR, Sahdev A, Drake WM, Akker SA. Succinate Dehydrogenase B (SDHB)-Associated Bladder Paragangliomas. Clin Genitourin Cancer 2017; 15:e131-e136. [DOI: 10.1016/j.clgc.2016.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/11/2016] [Indexed: 11/15/2022]
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Yadav S, Banerjee I, Tomar V, Yadav SS. Pelvic paraganglioma: a rare and unusual clinical presentation of paraganglioma. BMJ Case Rep 2016; 2016:bcr-2015-212851. [PMID: 26740269 DOI: 10.1136/bcr-2015-212851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paraganglioma of the urinary bladder is a rare tumour of the urinary bladder causing palpitation, headache, paroxysmal hypertension, tachycardia, blurring of vision and haematuria. Patients may present with these exaggerated symptoms during or just after micturition. We present a case of a 15-year-old girl who presented to us with accelerated hypertension, headache, palpitation and blurring of vision. On the basis of a positive family history, laboratory investigations and imaging studies, she was diagnosed to have an extra-adrenal paraganglioma. Complete enucleation of the tumour with preservation of the bladder was done. This case is reported because of the rarity of the disease in urology.
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Affiliation(s)
- Suresh Yadav
- Department of Urology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Indraneel Banerjee
- Department of Urology, Sawai Man Singh Medical College and Hospital, Kolkata, West Bengal, India
| | - Vinay Tomar
- Department of Urology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Sher Singh Yadav
- Department of Urology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
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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: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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Malignant paraganglioma of the bladder: A case report and review of the literature. Pathol Res Pract 2015; 211:183-8. [DOI: 10.1016/j.prp.2014.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/05/2014] [Accepted: 10/23/2014] [Indexed: 11/23/2022]
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Kumar S, Parmar KM, Singh S, Rani J. Pelvic pheochromocytoma mimicking as urinary bladder pheochromocytoma: looking beyond the obvious. J Clin Imaging Sci 2014; 4:56. [PMID: 25379349 PMCID: PMC4220420 DOI: 10.4103/2156-7514.143409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/21/2014] [Indexed: 11/04/2022] Open
Abstract
Pheochromocytomas located outside the adrenal glands are called paragangliomas. A pelvic location is rare, the most common location for a paraganglioma being the retroperitoneal space. Paragangliomas arise from neural crest cells. Pelvic pheochromocytomas may mimic urinary bladder pheochromocytomas on imaging studies. Patients may present with hypertensive crisis during micturition. We present a 26-year-old female who presented to us with accelerated hypertension with episodes of severe headache and palpitation during micturition. Based on imaging studies, she was diagnosed to have a urinary bladder pheochromocytoma. However, on exploration, the patient was found to have an extravesical pheochromocytoma arising from the left posterolateral pelvic wall, which was excised while preserving the bladder. We present this case report as pelvic pheochromocytomas can mimic bladder pheochromocytomas and are difficult to differentiate on radiological imaging and can lead to inadvertent cystectomy.
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Affiliation(s)
- Santosh Kumar
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kalpesh Mahesh Parmar
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivanshu Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jyotsna Rani
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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14
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Pahwa HS, Kumar A, Srivastava R, Misra S, Goel MM. Urinary bladder paraganglioma-a case series with proposed treating algorithm based on our experience and review of literature. Indian J Surg Oncol 2013; 4:294-7. [PMID: 24426742 PMCID: PMC3771045 DOI: 10.1007/s13193-013-0244-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/21/2013] [Indexed: 10/26/2022] Open
Affiliation(s)
| | | | | | - Sanjeev Misra
- />Department of Surgical Oncology, KGMU, Lucknow, India
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15
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Ahn SG, Jang H, Han DS, Lee JU, Yuk SM. Transurethral resection of bladder tumour (TURBT) as an optional treatment method on pheochromocytoma of the urinary bladder. Can Urol Assoc J 2013; 7:E130-4. [PMID: 23671503 DOI: 10.5489/cuaj.255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pheochromocytoma of the urinary bladder is rare. We have experienced a case of unexpected pheochromocytoma of the urinary bladder in a 45-year-old female. An ultrasonographic, computed tomography scan and cystoscopic examination showed a submucosal bladder mass. After transurethral resection of bladder tumour was performed, the bladder mass was confirmed as pheochromocytoma by a pathologist. After surgery, the patient underwent a subsequent pelvic magnetic resonance imaging, positron emission tomography and I(131)-methyliodobenzylguanidine (I(131)-MIBG). An image study showed no residual tumour sites and no lymphatic metastasis. The patient has had no tumour recurrence and no voiding symptoms 3 years after the surgery.
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Affiliation(s)
- Sun Gook Ahn
- Departments of Hospital Urology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
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16
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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: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [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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17
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Pahwa HS, Kumar A, Srivastava R, Rai A. Unsuspected pheochromocytoma of the urinary bladder: reminder of an important clinical lesson. BMJ Case Rep 2012; 2012:bcr-2012-006377. [PMID: 22878991 DOI: 10.1136/bcr-2012-006377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bladder pheochromocytoma creates an extremely rare situation (0.06% of all bladder tumours). We came across a case with a complaint of intermittent episodes of haematuria. Cystoscopy revealed a solid, bluish submucosal growth with increased vascularity. Immediately after taking biopsy, the patient developed a sharp headache, chest heaviness and marked rise in blood pressure. The procedure was abandoned. Later, serum and urinary markers for pheochromocytoma were within normal limits. The histopathology report came out to be pheochromocytoma of the bladder. Later, partial cystectomy was carried out under general anaesthesia and histopathology confirmed the same. Thus, a surgeon/urologist should have a high index of suspicion for bladder pheochromocytoma while dealing with such cases if he comes across the characteristic symptoms of sharp headache, hypertension, palpitation, sweating, fainting or blurring of vision immediately after voiding or during the cystoscopic manipulation of tumour or cystoscopic findings of a submucosal supratrigonal vascular tumour with a bluish hue.
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Yang Y, Wei ZT, Lu JS, Zu Q, Wang H, Zhang X. Transurethral partial cystectomy with 2 μm thulium continuous wave laser in the treatment of bladder pheochromocytoma. J Endourol 2011; 26:686-90. [PMID: 22007839 DOI: 10.1089/end.2011.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To introduce transurethal partial cystectomy with a 2013 nm thulium laser as a treatment for paraganglioma of the urinary bladder in adults. PATIENTS AND METHODS Three patients with pheochromocytomas were treated transurethrally with a 2013 nm thulium laser under general anesthesia. A 2013 nm thulium laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between the detrusor muscle layer and outer connective tissues. Tumors with full-thickness detrusor muscle layers at the base were removed together. Intraoperative fluctuation of blood pressure, preoperative values of 24-hour urine catecholamine (CA) and vanillylmandelic acid (VMA), and postoperative complications were observed, and postoperative followtwoups were performed. RESULTS All operations were successful. Operative time was 25 to 32 minutes. Perioperative blood pressure was stable in two cases while blood pressure fluctuated in the third case. When the entire tumor and the full-thickness bladder wall at the base were freed, blood pressure reverted to stability. All values of 24-hour urine CA and VMA were within normal limits postoperatively. Patients were followed for 7 to 9 months postoperatively with no recurrence. This series included highly selected patients who were treated by a single senior surgeon who is rich in experience in performing 2013 nm thulium laser procedures. CONCLUSIONS To our knowledge, this is the first report of a 2013 nm thulium laser used to treat bladder pheochromocytoma. It can be applied to precisely vaporize and incise the full-thickness bladder wall and cut down the blood supply of the tumor, then peel it while blood pressure remains stable, thus completing partial cystectomy for bladder pheochromocytoma safely.
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Affiliation(s)
- Yong Yang
- Department of Urology, PLA General Hospital, Beijing, China.
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19
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Bohn OL, Pardo-Castillo E, Fuertes-Camilo M, Rios-Luna NP, Martinez A, Sanchez-Sosa S. Urinary bladder paraganglioma in childhood: a case report and review of the literature. Pediatr Dev Pathol 2011; 14:327-32. [PMID: 21385006 DOI: 10.2350/10-10-0926-cr.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bladder paraganglioma (BP) is a rare entity and is exceedingly uncommon in childhood. Pheochromocytomas/paragangliomas are components of several hereditary cancer syndromes, and up to 30% may be associated with germ-line mutations of genes, including VHL, RET, and SDH. We present a 16-year-old female who was admitted with macroscopic hematuria and anemia. A cystoscopy demonstrated a polypoid and hemorrhagic mass arising from the floor of the bladder. She underwent a transurethral resection of clinically suspected urothelial papilloma. A histologic examination of the tumor showed large polygonal cells with eosinophilic cytoplasm, arranged in a zellballen pattern, surrounded by a fibrous network. Immunohistochemical studies showed a strong expression of neuroendocrine markers and lack of reactivity for epithelial markers. The diagnosis of BP was established; eight months later, a recurrence was observed and the patient underwent a partial cystectomy. Our case represents the 1st BP in childhood reported in the literature with absent SDHB staining by immunohistochemistry. We discuss the clinical and pathologic findings and present a review of BP in childhood.
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Affiliation(s)
- Olga L Bohn
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA.
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20
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21
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Wang H, Ye H, Guo A, Wei Z, Zhang X, Zhong Y, Fan Z, Wang Y, Wang D. Bladder paraganglioma in adults: MR appearance in four patients. Eur J Radiol 2010; 80:e217-20. [PMID: 20950973 DOI: 10.1016/j.ejrad.2010.09.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/09/2010] [Accepted: 09/20/2010] [Indexed: 12/17/2022]
Abstract
PURPOSE To document the magnetic resonance imaging (MRI) characteristics of paraganglioma of the urinary bladder in adults. MATERIALS AND METHODS The MRI findings and clinical features of pathologically-proven bladder paraganglioma in four patients (three men, one woman; age range, 39-62 years; mean age, 46.8 years) were reviewed retrospectively. All patients underwent MRI in a 1.5 T instrument. The MRI features of the lesions were analyzed, with emphasis on the size, shape, location, margin, signal intensity, degree of MRI enhancement, and apparent diffusion coefficient (ADC) values. RESULTS The bladder paragangliomas were located in the posterior vesicle wall (n=2), in the dome of the bladder wall (n=1), or the inferoanterior wall (n=1). On MR images, the tumors were round (n=1) or oval-shaped (n=3) and all exhibited well-circumscribed margins and broad-based attachment to the bladder wall. On T1-weighted images, the lesions demonstrated homogeneous hyperintensity (n=4) compared to the gluteus maximus muscle; while on T2-weighted images, they showed slight hyperintensity (n=4). On contrast-enhanced MR images, all lesions showed intense enhancement. On diffusion-weighted imaging (DWI), the lesions showed hyperintensity (n=4) and the mean ADC value was 0.973×10(-3) mm2/s. CONCLUSION Bladder pheochromocytoma appears as a round or oval-shaped intensely enhancing lesion with T1 hyperintensity; these characteristics may facilitate the preoperative determination.
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Affiliation(s)
- Haiyi Wang
- Department of Radiology, PLA General Hospital, Beijing, China
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22
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Recurrent urinary bladder paraganglioma. Adv Urol 2010:912125. [PMID: 20672008 PMCID: PMC2905915 DOI: 10.1155/2010/912125] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 04/09/2010] [Accepted: 05/26/2010] [Indexed: 12/14/2022] Open
Abstract
A 39-year-old male presented with recurrent attacks of painless haematuria. The patient has a history of partial cystectomy for bladder paraganglioma 10 years prior to the presentation. Imaging study and cystoscopic examination revealed a small anterior wall bladder tumor. The histological examination of the lesion confirmed that it was a urinary paraganglioma. Partial cystectomy was performed to this recurrent lesion. This case report stresses the importance of life-long follow-up of these lesions.
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23
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Madani R, Al-Hashmi M, Bliss R, Lennard TWJ. Ectopic pheochromocytoma: does the rule of tens apply? World J Surg 2007; 31:849-54. [PMID: 17372668 DOI: 10.1007/s00268-006-0608-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The rule of "tens" is often stated to reflect the distribution and histology of pheochromocytomas, with 10% being bilateral, 10%; ectopic in origin, and 10%; malignant. The objective of this study was to review the ectopic pheochromocytomas in a tertiary endocrine center and to establish whether the rule of tens holds true. METHODS Retrospective data were collected on all adrenalectomies and ectopic pheochromocytoma resections performed between 1993 and 2005 at our institution. RESULTS In total, 77 patients had pheochromocytomas: 75%; (58/77) adrenal and 25%; (19/77) ectopic. Of the adrenal pheochromocytomas, 10%; (6/58) were bilateral. The anatomic locations of the ectopic pheochromocytomas were as follows: 26%; (5/19) adjacent to the adrenals, 53%; (10/19) in the organ of Zuckerkandl, 11%; (2/19) in the bladder, 5%; (1/19) in the mediastinum, and 5%;(1/19) in the neck. CONCLUSIONS Our series demonstrates an incidence of 10%; for bilateral pheochromocytoma, which is similar to that in the published reports. However, 25%; of the pheochromocytomas were ectopic. Zuckerkandl pheochromocytomas were the most common among the ectopic lesions. Rarely, these tumors present outside the abdominal cavity.
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Affiliation(s)
- R Madani
- Department of Surgery, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, Tyne and Wear, NE1 4LP, UK
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24
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Abstract
Neuroendocrine differentiation in tumors of the upper and lower urinary tracts, prostate, and testis is rare. The current review surveys the most significant pathologic and clinical features of primary neuroendocrine lesions at these sites, with emphasis on the cell types from which they derive. As many tumors in this spectrum often bear strong morphologic resemblance to similar neoplasms in other organs, the importance of considering secondary involvement of the genitourinary tract cannot be overstated.
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Affiliation(s)
- Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
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25
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Dilbaz B, Bayoglu Y, Oral S, Cavusoglu D, Uluoglu O, Dilbaz S. Laparoscopic resection of urinary bladder paraganglioma: a case report. Surg Laparosc Endosc Percutan Tech 2006; 16:58-61. [PMID: 16552385 DOI: 10.1097/01.sle.0000202194.51699.2a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The case report of a 55-year-old woman with an incidentally diagnosed urinary paraganglioma of the bladder is presented. The patient had no irritative voiding symptoms, hematuria or hypertension. She was diagnosed to have an immobile solid mass on the left side neighboring the lower segment of the uterus. Transvaginal ultrasonography revealed a well-limited ovoid mass with solid and cystic areas adjacent to the urinary bladder and the uterus. Tumor markers were within normal range. Laparoscopy was performed for the treatment of the mass and complete excision of the cyst was accomplished. Frozen section was performed revealing a benign cystic structure but the identification of the origin was left to definitive histopathological examination which showed paraganglioma of the bladder. Immunohistochemically, the tumor cells were strongly positive for chromogranin A and synaptophysin and there was focal positiveness for neuron specific enolase although vimentin and cytokeratin were negative.
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Affiliation(s)
- Berna Dilbaz
- Department of Endoscopic Surgery, SSK (Social Security Organization), Maternity and Women's Health Training Hospital, Ankara, Turkey.
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26
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Campodonico F, Bandelloni R, Maffezzini M. Paraganglioma of the prostate in a young adult. Urology 2005; 66:657. [PMID: 16140099 DOI: 10.1016/j.urology.2005.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2004] [Revised: 02/07/2005] [Accepted: 03/01/2005] [Indexed: 11/28/2022]
Abstract
Extraadrenal pheochromocytomas, or paragangliomas, are rare and potentially malignant tumors that may occur in extraadrenal chromaffin tissue. The determination of malignant or benign represents the crucial point once the diagnosis has been established. We report a case of a 33-year-old man with an incidental paraganglioma involving the prostate. He underwent nerve-sparing radical retropubic prostatectomy and monolateral lymphadenectomy. Urinary continence was complete on postoperative day 5, and the patient had intercourse 2 weeks after surgery. The follow-up was at 24 months with no evidence of recurrent disease on clinical examination or body scan evaluation.
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27
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Zhou M, Epstein JI, Young RH. Paraganglioma of the urinary bladder: a lesion that may be misdiagnosed as urothelial carcinoma in transurethral resection specimens. Am J Surg Pathol 2004; 28:94-100. [PMID: 14707870 DOI: 10.1097/00000478-200401000-00011] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Paraganglioma of the urinary bladder is a rare tumor with characteristic histologic and immunohistochemical features. However, in our experience, it may be misdiagnosed as urothelial cancer because of 1) its frequent involvement of the muscularis propria; 2) morphology that may suggest urothelial cancer in transurethral resection specimens, particularly if there are artifactual changes induced by that procedure; 3) failure of pathologists to include it in their differential diagnosis when evaluating a bladder tumor; and 4) only a minority of the cases are associated with symptoms that might prompt consideration of the diagnosis. Distinction between paraganglioma and urothelial cancer is important because of likely different therapeutic options. In this report, we describe our experience with the histopathology of paragangliomas of the urinary bladder with emphasis on the histologic features that have led to their being misdiagnosed as conventional urothelial cancer and, most importantly, those that will help pathologists recognize this rare tumor of the bladder. Fifteen cases of paraganglioma of the urinary bladder were studied, 11 of them consult cases. They affected patients (8 male, 7 female) with a mean age of 49.5 years; only two had symptoms suggestive of the diagnosis, including hypertension during cystoscopy and episodic headache. Three consult cases were submitted with a diagnosis of "transitional cell carcinoma" and 4 with a diagnosis only of "bladder tumor." Histologically, "zellballen" and diffuse patterns were present in 12 (80%) and 3 (20%) of the cases. A delicate fibrovascular stroma was obvious in 14 (93%) cases. Other patterns included irregular nests and pseudorosette formation. Tumor necrosis, significant cautery artifact, and muscularis propria invasion were present in 1 (7%), 3 (20%) cases, and 10 (67%) cases, respectively. All 15 tumors were composed of large polygonal cells with abundant granular cytoplasm. Focal clear cells were present in 3 (20%). The nuclei were mostly uniform, although occasional pleomorphic nuclei were seen in 6 (40%) cases, and 2 (13%) had frequent pleomorphic nuclei. Mitoses were rare overall, and no abnormal mitotic figures were found. The major histologic features that led to misdiagnosis included a diffuse growth pattern, focal clear cells, necrosis, and muscularis propria invasion, with significant cautery artifact compounding the diagnostic problems. Immunohistochemically, 2 of 2 tumors were positive for neuron-specific enolase, 9 of 10 tumors for chromogranin, and 2 of 3 tumors for synaptophysin; 3 of 3 tumors were negative for cytokeratin and 1 of 1 tumor negative for HMB-45. Paraganglioma of the urinary bladder may be misdiagnosed as urothelial cancer, but a careful search for the characteristic histologic features and, if necessary, supportive immunohistochemical studies, should lead to a correct diagnosis.
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Affiliation(s)
- Ming Zhou
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland 02114, USA
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28
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Onishi T, Sakata Y, Yonemura S, Sugimura Y. Pheochromocytoma of the urinary bladder without typical symptoms. Int J Urol 2003; 10:398-400. [PMID: 12823696 DOI: 10.1046/j.1442-2042.2003.00645.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pheochromocytoma of the urinary bladder is an unusual tumor that typically presents with hypertensive crises related to micturition. We report, herein, the case of a 62-year-old woman with bladder pheochromocytoma. The patient presented with a bladder tumor that was incidentally found by computed tomography (CT) without the triad of sustained hypertension, hematuria and postmicturitional syncope. Cystoscopy revealed a yellowish submucosal tumor in the right lateral wall of the bladder. Treatment consisted of transurethral resection in the initial diagnosis of bladder tumor. A definitive diagnosis was made postoperatively upon pathological examination. The patient has been followed up for 12 months and has shown no recurrence.
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Affiliation(s)
- Takehisa Onishi
- Department of Urology, Prefectural Shima Hospital, Shima, Japan.
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29
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Abstract
Paragangliomas of the urinary bladder are very rare. To date, there are no reliable methods for predicting their clinical behavior, so long-term follow-up is required. We describe a paraganglioma of the urinary bladder in a 32-year-old male who presented with painless gross hematuria. Abdominal ultrasonography revealed a protruding mass with hematoma over the right lateral wall of the urinary bladder. The tumor was not completely resected by transurethral resection of bladder tumor (TURBT) due to intermingling with the bladder wall. Follow-up I131-metaiodobenzylguanidine was performed 3 weeks after surgery and suspected incomplete resection lesions were noted. Histologic examination of the tumor indicated paraganglioma of the urinary bladder. We also provide a brief review of the literature for comparison.
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Affiliation(s)
- Wan-Yi Kang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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30
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Ansari MS, Nabi G, Singh I, Hemal AK, Pandey G. Colovesical fistula an unusual complication of cytotoxic therapy in a case of non-Hodgkin's lymphoma. Int Urol Nephrol 2002; 33:373-4. [PMID: 12092659 DOI: 10.1023/a:1015269830795] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 65-year old man, a known case of non-Hodgkin's lymphoma of base of the tongue and epiglottis presented with complaints of pneumaturia and faecaluria. He had received the first cycle of cytotoxic therapy (CHOP-regimen). At the end of the cycle he developed febrile neutropenia (circulating granulocyte count <1500/mm3). Cystogram showed air in the bladder area and a fistulous communication to a cavity behind the bladder. CT-scan showed air in the bladder, a fistulous communication between the sigmoid colon and bladder along with an intervening small abscess cavity. On exploration a fistulous communication between the sigmoid and bladder along with an intervening small abscess cavity was found. Resection of involved portion of sigmoid and end to end anastomosis along with a diverting colostomy was done. The bladder was closed in two layers with an omental interposition between it and the sigmoid along with a suprapubic cystostomy. The histopathology demonstrated only inflammatory response without any evidence of malignancy or diverticular disease.
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Affiliation(s)
- M S Ansari
- Department of Urology and Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi
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31
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Ansari MS, Goel A, Goel S, Durairajan LN, Seth A. Malignant paraganglioma of the urinary bladder. A case report. Int Urol Nephrol 2002; 33:343-5. [PMID: 12092652 DOI: 10.1023/a:1015253427161] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Paraganglioma (pheochromocytoma) is probably the most fascinating of all tumors as it can present with a wide range of clinical manifestations. Paraganglioma of the urinary bladder is one of the rare tumors and constitute less than 10% of all bladder tumors. The common presentation of paraganglioma of the urinary bladder is painless haematuria, headache, palpitation and anxiety. Malignancy is uncommon and no histological feature is characteristic of malignancy. Invasion of adjacent organs or metastasis to the lymph nodes is the only criteria to suggest malignancy. In the presence of proven metastasis radical cystectomy with pelvic lymphadenectomy is recommended. In the present case the tumor was arising from anterior wall of the bladder away from the bladder neck and that in a large capacity bladder it was possible to get a wide margin for partial cystectomy along with bilateral pelvic lymphadenectomy without violating the oncological principles. At a follow up of two years there is no evidence of recurrence of tumor.
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Affiliation(s)
- M S Ansari
- Department of Urology and Pathology, All India Institute of Medical Sciences, New Delhi
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32
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Suárez Piñera M, Alonso JC, Bittini A, Domínguez P, Almoguera I, Ortega A, Pérez-Vázquez JM. [Urinary pheochromocytoma with normal hormone levels]. Rev Clin Esp 2001; 201:226-7. [PMID: 11447917 DOI: 10.1016/s0014-2565(01)70804-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Pheochromocytoma primarily involving the bladder is an uncommon pathologic finding. Patients may present with transient hypertension associated with palpitations and diaphoresis on micturition. A case of bladder pheochromocytoma treated by laparoscopic partial cystectomy is presented. The management principles of bladder pheochromocytoma for our specific case are discussed. Successful treatment requires that the correct diagnosis and tumor location be made in conjunction with the obligatory preoperative preparation of the patient.
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Affiliation(s)
- P M Kozlowski
- Department of Urology, Stanford University, Stanford, California, USA
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34
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Cheng L, Leibovich BC, Cheville JC, Ramnani DM, Sebo TJ, Neumann RM, Nascimento AG, Zincke H, Bostwick DG. Paraganglioma of the urinary bladder: can biologic potential be predicted? Cancer 2000; 88:844-52. [PMID: 10679654 DOI: 10.1002/(sici)1097-0142(20000215)88:4<844::aid-cncr15>3.0.co;2-i] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Paraganglioma of the urinary bladder is rarely encountered and its biologic behavior is uncertain. The authors sought to determine the prognostic factors that would predict patient outcome. METHODS The Mayo Clinic experience over 53 years with paraganglioma of the bladder was reviewed. All histologic slides from 16 patients were reviewed by the authors. Eight cases were examined immunohistochemically with cytokeratin (AE1/3, cytokeratin 7, and cytokeratin 20), vimentin, S-100 protein, neuroendocrine markers (chromogranin, synaptophysin, and neuron specific enolase), p53 protein, and MIB-1. DNA ploidy was determined by digital image analysis in formalin fixed, paraffin embedded tissue. The mean follow-up was 6.3 years (range, 0.4-16.4 years). RESULTS Paraganglioma usually occurred in young adult women (mean age, 45 years; range, 16-74 years). The male-to-female ratio was 1 to 3. The common symptoms and signs were hypertension and hematuria. The tumors were usually located intramurally in the lateral and posterior wall of the bladder and were multifocal in 3 cases (18%). Seven patients were treated by transurethral resection, eight by partial cystectomy, and one by radical cystectomy. T classification was T1 (1 patient), T2 (9 patients), T3 (2 patients), and T4b (4 patients). At the time of diagnosis, one patient had distant metastasis and one had regional lymph node metastasis. One patient developed metastasis 1 year after diagnosis and died of the disease 1.5 years later. None of the patients with T1 or T2 tumors had recurrence or tumor progression. All tumors were aneuploid. The mean MIB-1 labeling index was 1.5% (range, 0.03-7.0%). The tumor cells displayed immunoreactivity for S-100 protein and neuroendocrine markers and were negative for p53 (except 1 case) and cytokeratin. CONCLUSIONS Paraganglioma of the urinary bladder occurs mostly in young adult women. Patients with tumor of advanced classification (>/=T3) are at risk of recurrence, metastasis, and dying of the disease, whereas patients in this study with T1 or T2 disease had favorable outcomes after complete tumor resection.
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Affiliation(s)
- L Cheng
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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35
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Kato H, Suzuki M, Mukai M, Aizawa S. Clinicopathological study of pheochromocytoma of the urinary bladder: immunohistochemical, flow cytometric and ultrastructural findings with review of the literature. Pathol Int 1999; 49:1093-9. [PMID: 10632931 DOI: 10.1046/j.1440-1827.1999.00985.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pheochromocytomas usually arise from the adrenal medulla but may also arise from the carotid body, the retroperitoneum, the urinary bladder, and other locations. We report three cases of pheochromocytoma of the urinary bladder with clinicopathological, immunohistochemical, flow cytometric, and ultrastructural findings. Case 1, a 13-year-old boy presented with hematuria. He underwent partial cystectomy, 31 years later he presented with a tumor in the thoracic vertebra. Case 2, a 35-year-old woman presented with headache, nausea, vomiting, palpitations, and diaphoresis on evacuation. She underwent total cystectomy and regional lymph adenectomy. She survived for 10 years without recurrence or metastasis; however, she died from another disease. Case 3, a 31-year-old man presented with dysuria. He underwent total cystectomy and regional lymph adenectomy. The tumor metastasized to the lymph nodes, and the patient died after 4 years. The urinary bladder tumors in these three cases protruded into the lumen and invaded deeper than the middle of the muscle layer. The tumor of the urinary bladder, metastatic lymph nodes, and thoracic vertebra showed alveolar and trabecular patterns, and tumor cells were surrounded by capillaries. The tumor cells were moderate in size with ovoid nuclei and abundant eosinophilic cytoplasm that contained acidophilic granules reactive to Grimelius stain. Vascular invasion was observed in cases 1 and 2. Immunohistochemically, tumor cells showed reactivity for chromogranin, Leu 7, and S-100 protein. In each of the three cases, the DNA ploidy pattern on flow cytometry was aneuploid. Ultrastructural examination revealed several neurosecretory granules, rough endoplasmic reticulum, and a few mitochondria within the cytoplasm. It is difficult to determine whether pheochromocytoma of the urinary bladder is malignant on the basis of histological, immunohistochemical, and flow cytometric findings. Long-term follow up is necessary.
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Affiliation(s)
- H Kato
- Department of Pathology, Jikei University, School of Medicine, Tokyo, Japan
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36
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Sandur S, Dasgupta A, Shapiro JL, Arroliga AC, Mehta AC. Thoracic involvement with pheochromocytoma: a review. Chest 1999; 115:511-21. [PMID: 10027454 DOI: 10.1378/chest.115.2.511] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Pulmonary manifestations of pheochromocytoma are infrequent and are not well documented. A MEDLINE search in the English language revealed no cases of endobronchial involvement from a pheochromocytoma. We report a case of endobronchial metastases in a 37-year-old woman known to have a recurrent extra-adrenal pheochromocytoma. She presented with symptoms of wheezing and a nonproductive cough for 8 months and was being treated for asthma. A flexible bronchoscopy with endobronchial biopsy established the diagnosis. The patient underwent a Nd-YAG laser photoresection (LPR) to ablate the tumor, which was followed by placement of a Wallstent (Pfizer Medical Technology Group; Rutherford, NJ). She remains well 18 months later, having required multiple palliative LPRs. To our knowledge, this is the first reported case of endobronchial pheochromocytoma. The pulmonary manifestations of this rare disease and their management are reviewed.
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Affiliation(s)
- S Sandur
- Department of Pulmonary and Critical Care Medicine, The Cleveland Clinic Foundation, OH 44195, USA
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37
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Lydakis C, Hollinrake K, Lip GY. An unusual cause of palpitations requiring atrioventricular node ablation and pacemaker therapy. Blood Press 1997; 6:368-71. [PMID: 9495663 DOI: 10.3109/08037059709062097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report the unique case of a patient who complained of palpitations resistant to many antiarrhythmic treatment strategies, finally requiring treatment with atrioventricular node ablation and pacemaker implantation. A pheochromocytoma was eventually diagnosed, 16 years after the onset of her symptoms.
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Affiliation(s)
- C Lydakis
- University Department of Medicine, City Hospital, Birmingham, UK
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38
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Affiliation(s)
- E Takimoto
- Department of Anesthesiology, Kochi Medical School, Japan
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39
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Takimoto E, Ueda W. Unsuspected Pheochromocytoma of the Urinary Bladder. Anesth Analg 1995. [DOI: 10.1213/00000539-199506000-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rhaman SI, Matthews LK, Shaikh H, Townell NH. Primary paraganglioma of the bladder in a 14-year-old boy. BRITISH JOURNAL OF UROLOGY 1995; 75:682-3. [PMID: 7613815 DOI: 10.1111/j.1464-410x.1995.tb07439.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- S I Rhaman
- Department of Urology, Stracathro Hospital, Brechin, UK
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41
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Abstract
Pheochromocytoma, although rare, is associated with a high degree of morbidity and mortality if not recognized. A high degree of suspicion in patients with new-onset hypertension; hypertension with sudden worsening or development of diabetes mellitus; or a family history of MEN, neuroectodermal tumors, or simple pheochromocytoma should prompt biochemical confirmation with either 24-hour urine catecholamines (norepinephrine and epinephrine) or total MET (NMET plus MET). Following confirmation of the diagnosis, radiologic studies with CT and (if needed) MIBG are employed to localize the tumor. Surgical removal is the only definitive therapy. Medical management with alpha-blocking agents, to control symptoms and prevent a hypertensive crisis, is generally advocated for 2 weeks preoperatively and intraoperatively. Occasionally, beta-blockers, employed only after adequate alpha-blockade, are necessary to control tachycardia and tachyarrhythmias. High-dose MIBG and combination chemotherapy have been used adjunctively to treat malignant pheochromocytoma, although neither modality provides lasting satisfactory results. Normal urine assays performed 2 weeks postoperatively ensure the complete removal of all tumor. Additionally, lifelong follow-up (yearly initially) is necessary to detect any signs of benign recurrence or malignancy because these have been reported to occur as long as 41 years after the initial surgical resection. Biochemical evidence of excess catecholamine production usually precedes the clinical manifestations of catecholamine excess when these tumors recur.
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Affiliation(s)
- S S Werbel
- Department of Internal Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina
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Thrasher JB, Rajan RR, Perez LM, Humphrey PA, Anderson EE. Pheochromocytoma of urinary bladder: contemporary methods of diagnosis and treatment options. Urology 1993; 41:435-9. [PMID: 8488611 DOI: 10.1016/0090-4295(93)90503-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Two patients with vesical pheochromocytoma are presented with a review of the literature. Imaging modalities for localizing extra-adrenal pheochromocytomas are reviewed with an overview of the commonly accepted treatment options. Successful treatment of this lesion requires a high index of suspicion based upon the patient's symptom complex, allowing preoperative preparation prior to surgical manipulation.
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Affiliation(s)
- J B Thrasher
- Department of Surgery (Division of Urology) Duke University Medical Center, Durham, North Carolina
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43
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Abstract
Extra-adrenal pheochromocytomas may arise in any portion of the paraganglion system, although they most commonly occur below the diaphragm. The most common site of occurrence of extra-adrenal pheochromocytoma is the superior para-aortic region between the diaphragm and lower renal poles. Although the traditional teaching has been that 10% of all pheochromocytomas are at extra-adrenal sites, this may be an underestimation. Extra-adrenal pheochromocytomas probably represent at least 15% of adult and 30% of childhood pheochromocytomas. They may be malignant in up to 40% of the cases, although conflicting data add to the uncertainty of this point. Patients with tumors arising at extra-adrenal sites commonly present with headache, palpitations, sweating and hypertension. The diagnosis is most often confirmed by demonstrating increased catecholamine production, usually by measurement of urinary catecholamines and/or their metabolites. CT scanning is presently the imaging procedure of choice for localization. The roles of MRI and 131I-MIBG scintigraphy in the localization process are still being determined. Thorough preoperative pharmacological preparation, attentive intraoperative monitoring and aggressive surgical therapy all have an important role in achieving the safest and most successful outcome. Complete surgical excision is the treatment of choice for primary extra-adrenal pheochromocytoma as well as recurrent or metastatic disease. When residual tumor cannot be resected, medical therapy for symptomatic relief is preferred, since radiotherapy and chemotherapy have limited effectiveness. Extra-adrenal pheochromocytomas are more likely to recur and to metastasize than their adrenal counterparts, making lifelong followup with annual determinations of catecholamine production essential.
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Affiliation(s)
- R K Whalen
- Department of Urology, Massachusetts General Hospital, Boston
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Hansen LU, Jess P, Hermansen K, Lorentzen M. Phaeochromocytoma--an unusual cause of haematuria. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1992; 26:319-21. [PMID: 1439611 DOI: 10.3109/00365599209180893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A patient was admitted to hospital because of haematuria. A papillomatous bladder tumor was removed. Histological examination revealed a phaeochromocytoma. Fourteen days postoperatively the urinary excretion rates of catecholamines were elevated but normalized afterwards. Abdominal computed tomography and metaiodobenzylguanidine scintigraphy were normal. No hypertension or characteristic micturitional attacks preceded removal of the tumor.
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Affiliation(s)
- L U Hansen
- Department of Surgery, Fåborg Hospital, Denmark
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45
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Counselman FL, Brenner CJ, Brenner DW. Adrenal pheochromocytoma presenting with persistent abdominal and flank pain. J Emerg Med 1991; 9:241-6. [PMID: 1861058 DOI: 10.1016/0736-4679(91)90420-k] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Pheochromocytoma is classically associated with paroxysms of headache and hypertension. Its presentation, however, may be more varied and subtle. We present a case of an adolescent female who complained of right upper quadrant and flank pain. A right adrenal pheochromocytoma was diagnosed and subsequently removed. The pertinent literature is discussed.
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Affiliation(s)
- F L Counselman
- Department of Emergency Medicine, Eastern Virginia Graduate School of Medicine
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46
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Pheochromocytoma of the bladder. World J Urol 1989. [DOI: 10.1007/bf01637380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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47
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Heyman J, Cheung Y, Ghali V, Leiter E. Bladder pheochromocytoma: evaluation with magnetic resonance imaging. J Urol 1989; 141:1424-6. [PMID: 2724441 DOI: 10.1016/s0022-5347(17)41334-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 17-year-old black woman with a large vesical pheochromocytoma was managed successfully by hemicystectomy and ureteroneocystotomy. Preoperatively, in addition to the routine diagnostic evaluation, magnetic resonance imaging was performed. Magnetic resonance imaging proved to be an extremely useful modality to assess the integrity of the bladder wall and extent of extravesical involvement.
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Affiliation(s)
- J Heyman
- Department of Urology, Beth Israel Medical Center, New York, New York
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48
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Burton EM, Schellhammer PF, Weaver DL, Woolfitt RA. Paraganglioma of urinary bladder in patient with neurofibromatosis. Urology 1986; 27:550-2. [PMID: 3087046 DOI: 10.1016/0090-4295(86)90341-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pheochromocytoma in patients with von Recklinghausen's neurofibromatosis is a well-known association. However, extra-adrenal pheochromocytoma with this association is rare. Herein we report a case of urinary bladder paraganglioma in a patient with neurofibromatosis.
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Russo P, Balfe DM, Weiss A, Sicard G. Micturitional hypertension and retropubic mass. UROLOGIC RADIOLOGY 1984; 6:230-3. [PMID: 6516094 DOI: 10.1007/bf02923734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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