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Paraganglioma of the Urinary Bladder in a Dog. J Comp Pathol 2022; 195:1-6. [DOI: 10.1016/j.jcpa.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/24/2022] [Accepted: 04/15/2022] [Indexed: 11/23/2022]
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Hooshyari A, Tyson M, Rice M. Paraganglioma (pheochromocytoma) of the urinary bladder: A systematic review with a diagnostic, management and treatment algorithm. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221090329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Paraganglioma of the urinary bladder is a rare but well-documented tumour. Herein, we provide the largest, comprehensive systematic review of the literature and aim to increase familiarity with this rare but significant neoplasm. Methods: A systematic review of the literature was conducted on the NCBI PubMed database. The search criteria were not limited to any specific years or languages. There were 418 articles between January 1953 and August 2020, of which 255 case reports were selected. Results: Paragangliomas of the urinary bladder most commonly occurred in Caucasians in the fifth decade of life, most commonly presenting with haematuria and variations of ‘micturition attacks’. Eighty percent of tumours were functionally active. The mucosa was normal in 91% of patients. In all, 25% of tumours were treated with transurethral resection alone, 65% had partial cystectomy and 5% had radical cystectomy. Alpha-blockers were administered pre-operatively in 38% of patients and the risk of intra-operative hypertensive crisis was over three times greater in those who did not receive an alpha-blocker. The tumour was confined to the bladder in 75% of cases. Metastasis occurred in 20% of cases, most commonly to iliac nodes. The mean follow-up time was 26.5 months. In cases that documented follow-up, 18.6% had recurrence, most commonly in lymph nodes and bone. Conclusion: All patients presenting with micturition attacks or haematuria with a computed tomography showing an enhancing, well-defined submucosal bladder lesion and/or cystoscopy showing a lesion with normal overlying mucosa should be worked up for a possible paraganglioma of the urinary bladder. Level of evidence: Not applicable
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Affiliation(s)
- Ali Hooshyari
- Urology Department, Auckland City Hospital, Auckland District Health Board, New Zealand
| | - Matthew Tyson
- Urology Department, Auckland City Hospital, Auckland District Health Board, New Zealand
| | - Michael Rice
- Urology Department, Auckland City Hospital, Auckland District Health Board, New Zealand
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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: 1.6] [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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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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El-Tholoth HS, Al Rasheedi S, Alharbi F, Alshammari W, Alzahrani T, Al Zahrani A. Paraganglioma of Urinary Bladder Managed by Laparoscopic Partial Cystectomy in Conjunction with Flexible Cystoscopy: A Case Report. J Endourol Case Rep 2018; 4:15-17. [PMID: 29468198 PMCID: PMC5820683 DOI: 10.1089/cren.2017.0132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Paraganglioma of the urinary bladder (PUB) is exceedingly rare, accounting for <0.1% of all urinary bladder tumors. Various challenging treatment options are available. Case Presentation: A 67-year-old female presented with malignant hypertension on four medications for which investigation was done. An observation of having functioning PUB was noted. She was admitted and laparoscopic partial cystectomy was done with the guidance of flexible cystoscopy. She had a smooth postoperative course and was discharged home, then catheter was removed after cystogram. Histopathology confirmed the diagnosis of a bladder paraganglioma. Finally, during the last follow-up, the patient was asymptomatic with controlled blood pressure and normalized catecholamine levels with no evidence of recurrence. Conclusion: PUB is an exceedingly rare tumor that can be managed with minimally invasive techniques such as laparoscopic partial cystectomy with cystoscopy guidance.
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Affiliation(s)
- Hossam S El-Tholoth
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sami Al Rasheedi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Faris Alharbi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Waleed Alshammari
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Tarek Alzahrani
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmed Al Zahrani
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Gupta S, Zhang J, Rivera M, Erickson LA. Urinary Bladder Paragangliomas: Analysis of Succinate Dehydrogenase and Outcome. Endocr Pathol 2016; 27:243-52. [PMID: 27262318 DOI: 10.1007/s12022-016-9439-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Paragangliomas of the urinary bladder can arise sporadically or as a part of hereditary syndromes including those with underlying mutations in the succinate dehydrogenase (SDH) genes, which serve as tumor suppressors. SDH deficiency can be screened for by absence of immunohistochemical detection of SDHB. In this study of 11 cases, clinical follow-up was available for 9/11 cases. The cases were reviewed and graded based on the grading system for adrenal pheochromocytomas and paragangliomas (GAPP) criteria. Immunohistochemistry was performed for Ki67 and SDHB. Proliferative index was calculated by quantification of Ki67-positive cells at hot spots. The medical record was accessed for documentation of germline SDH mutations. Urinary bladder paragangliomas had a female predilection (8/11 cases), and 5/11 cases exhibited metastatic behavior. Patients with metastatic disease tended to be younger (mean age 43 vs 49 years), have larger lesions (5.8 vs 1.5 cm), and presented with catecholamine excess (4/4 vs 2/6 patients with non-metastatic lesions). Patients with metastatic disease had a higher mean Ki67 proliferation rate (4.9 vs 1.3 %) and GAPP score (mean of 5.8 vs 3.8) (p = 0.01). IHC for SDHB expression revealed loss of expression in 2/6 cases of non-metastatic paragangliomas compared to 4/5 patients with metastatic paragangliomas. Interestingly, of these four patients, two had a documented mutation of SDHB, one patient had a SDHC mutation, and another patient had a history of familial disease without mutation analysis being performed. Our study, suggests that SDH loss was suggestive of metastatic behavior in addition to younger age at diagnosis, larger tumor size, and higher Ki67 proliferation rate and catecholamine type.
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Affiliation(s)
- Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jun Zhang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael Rivera
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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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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9
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Sherwani P, Anand R, Narula MK, Siddiqui AA, Aggarwal S. Concurrent nonfunctional paraganglioma of the retroperitoneum and urinary bladder: A case report with literature review. Indian J Radiol Imaging 2015; 25:198-201. [PMID: 25969646 PMCID: PMC4419432 DOI: 10.4103/0971-3026.155879] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Paragangliomas are the neuroendocrine tumors which arise from the chromaffin cell. Tumors arising from the adrenal medulla are known as pheochromocytomas, while others originating from the extra-adrenal site are known as extra-adrenal paragangliomas. Paraganglioma can be multifocal which can arise synchronously or metachronously. Paragangliomas are less functionally active than the pheochromocytomas; they secrete noradrenaline and rarely dopamine, while adrenal pheochromocytomas secrete adrenaline or nor-adrenaline. Nonfunctional multifocal paragangliomas are very rare. We report a case of a 45-year-old female with multifocal nonfunctional paragangliomas of the retroperitoneum and urinarybladder which were surgically removed, and the diagnosis was confirmed on histopathology
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Affiliation(s)
- Poonam Sherwani
- Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Rama Anand
- Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Mahender Kaur Narula
- Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Azaz Akhtar Siddiqui
- Department of Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Shilpi Aggarwal
- Department of Pathology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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10
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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: 21] [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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Verma A, Pandey D, Akhtar A, Arsia A, Singh N. Non-functional paraganglioma of retroperitoneum mimicking pancreatic mass with concurrent urinary bladder paraganglioma: an extremely rare entity. J Clin Diagn Res 2015; 9:XD09-XD11. [PMID: 25859512 DOI: 10.7860/jcdr/2015/11156.5570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/01/2015] [Indexed: 01/23/2023]
Abstract
Paragangliomas are extra-adrenal tumours of the autonomic nervous system, which rarely present as primary retroperitoneal mass mimicking pancreatic malignancy (incidence 2-8 per million populations). Urinary Bladder Paraganglioma are also extremely rare (0.06% of all Bladder Tumour and 6% of Paragangliomas) with most being malignant and high grade tumours. Non-functional varieties of both tumours are usually incidentally diagnosed. The possibility for malignant transformation in them makes surgical excision the treatment of choice. A 45-year-old lady with abdominal pain was investigated to have a complex retroperitoneal mass behind head of pancreas and a urinary bladder mass. Complete excision of retroperitoneal and bladder lesion was done. Histopathological examinations of both specimens were suggestive of Paraganglioma with no abnormal mitotic activity and capsular/vascular invasion. Although concurrent non functional paragangliomas had been reported but the synchronous non-functional paragangliomas of retroperitoneum and urinary bladder reported in this case is extremely rare and is not reported so far in English literature.
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Affiliation(s)
- Ankur Verma
- Senior Resident, Department of Surgery, Lady Harding Medical College and SSKH , New Delhi, India
| | - Diwakar Pandey
- Post graduate Student, Department of Surgery, Lady Harding Medical College and SSKH , New Delhi, India
| | - Azaz Akhtar
- Assistant Professor, Department of Surgery, Lady Harding Medical College and SSKH , New Delhi, India
| | - Ashish Arsia
- Associate Professor, Department of Surgery, Lady Harding Medical College and SSKH , New Delhi, India
| | - Nain Singh
- Associate Professor, Department of Surgery, Lady Harding Medical College and SSKH , New Delhi, India
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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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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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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: 89] [Impact Index Per Article: 8.1] [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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15
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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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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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17
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Xu DF, Chen M, Liu YS, Gao Y, Cui XG. Non-functional paraganglioma of the urinary bladder: a case report. J Med Case Rep 2010; 4:216. [PMID: 20642819 PMCID: PMC2913981 DOI: 10.1186/1752-1947-4-216] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 07/19/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Paragangliomas that originate from the urinary bladder are extremely rare. In most series, bladder paragangliomas often cause micturitional attacks. Treatment modalities include transurethral resection and cystectomy (partial or total). Prognosis of bladder paraganglioma is similar to that of adrenal pheochromocytoma. CASE PRESENTATION A 55-year-old Chinese woman presenting with the sole complaint of lower abdominal pain for one month was admitted to our hospital. Ultrasound and computed tomography revealed a mass on the dome of the bladder measuring 4.0 x 3.0 cm. The tumor was completed removed by laparoscopic partial cystectomy. Histological examination of the tumor indicated paraganglioma of the urinary bladder. The clinical features, diagnosis, management and pathological findings of paraganglioma of the urinary bladder are discussed. CONCLUSIONS Bladder paraganglioma should be considered as a differential diagnosis to neoplasm in the urinary bladder, although there is no characteristic symptom. Laparoscopic partial cystectomy may be the first choice in treating paraganglioma of the urinary bladder, offering several advantages such as less invasion, rapid recovery and early discharge from the hospital.
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Affiliation(s)
- Dan-Feng Xu
- Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
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18
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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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19
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Abstract
A 16-year-old girl came to our emergency department because of severe headache. For the past 3 years, she had presented at several emergency departments with a similar problem. When she was hospitalized for further investigation, she developed severe arterial hypertension for which an unusual cause was found by imaging of the abdomen.
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Affiliation(s)
- Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, Republic of China
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20
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Davis MA, Bove GM. A Case of Pheochromocytoma Presenting as Low Back Pain. J Manipulative Physiol Ther 2007; 30:598-601. [DOI: 10.1016/j.jmpt.2007.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 05/31/2007] [Accepted: 06/26/2007] [Indexed: 10/22/2022]
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21
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Celiktaş M, Okur N, Aikimbaev KS, Binokay F, Sert M, Akgül E. Bladder pheochromocytoma encountered on sonography. ACTA ACUST UNITED AC 2004; 48:398-400. [PMID: 15344994 DOI: 10.1111/j.0004-8461.2004.01326.x] [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] [Indexed: 11/30/2022]
Abstract
Pheochromocytomas of the bladder are rare neoplasms, constituting < 0.06% of all vesical tumours. Common presenting features of this tumour include episodes of sweating, hypertension, haematuria and postmicturition syncope. We describe a case of bladder pheochromocytoma in a 66-year-old man whose only symptom of macroscopic haematuria was initially assessed with ultrasonography. Clinical presentation highlights the need for a high index of suspicion during sonographic evaluation of bladder neoplasms because such tumours might present without symptoms of adrenergic excess.
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Affiliation(s)
- M Celiktaş
- Department of Radiology, Medical Faculty, Cukurova University, Balcali Hospital, Adana, Turkey
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22
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Yoshida S, Nakagomi K, Goto S, Kobayashi S. Malignant pheochromocytoma of the urinary bladder: Effectiveness of radiotherapy in conjunction with chemotherapy. Int J Urol 2004; 11:175-7. [PMID: 15009367 DOI: 10.1111/j.1442-2042.2003.00758.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 34-year-old Japanese man with malignant pheochromocytoma of the bladder underwent surgical resection and chemoradiotherapy for a local recurrence of lymph node metastasis. Radiotherapy seemed to be effective, indicated by the growth inhibition of the irradiated tumor, decreases in serum and urinary catecholamine levels and a clinical improvement in the refractory stage of the combined chemotherapy.
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Affiliation(s)
- Soichiro Yoshida
- Departments of Urology 2Radiology, Hamamatsu Medical Center, Hamamatsu, Japan.
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23
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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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24
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Miladi M, Hajri M, Bacha K, Salami S, Ben Hassine L, Ayed M. [Extra-adrenal pheochromocytoma: report of 4 cases]. ANNALES D'UROLOGIE 2003; 37:13-6. [PMID: 12701315 DOI: 10.1016/s0003-4401(02)00006-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extra-adrenal pheochromocytoma is rare. The diagnosis must be evoked in signs of pheochromocytoma with absence of tumor of the adrenal. We report four cases of ectopic pheochromocytoma while specifying their clinical particularities and diagnosis procedure.
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Affiliation(s)
- M Miladi
- Service d'urologie, hôpital Charles Nicolle, boulevard 9 avril, Tunis, Tunisie.
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25
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Abstract
Phaeochromocytoma of the urinary bladder is rare. We report a case of a patient with undiagnosed bladder phaeochromocytoma who developed haemodynamic disturbances during routine diagnostic cystoscopy. The diagnosis was only confirmed postoperatively.
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Affiliation(s)
- S M Tan
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore
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26
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Abstract
The case of a 65-year-old male with pheochromocytoma arising in the urinary bladder is presented. Clinical evaluation included ultrasonography, intravenous pyelography and computerized tomography (CT) scan. Transurethral resection of an exophytic tumor 1 cm in diameter was performed. The histological diagnosis was pheochromocytoma of the bladder. The evaluation and management of this type of tumor is discussed.
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Affiliation(s)
- Figen Doran
- Department of Pathology, Cukurova University, Faculty of Medicine, Adana, Turkey
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27
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Abstract
Pheochromocytoma is a rare but important tumor in children. Appropriate evaluation and management are essential for a favorable outcome. Pheochromocytomas are more often multifocal and extra-adrenal in children when compared with adults. This pattern makes the diagnosis, localization, and surgical management more challenging. Nonetheless, the standard biochemical evaluation is usually diagnostic, and MR imaging is currently the best tool for tumor localization. The possibility of a familial syndrome must always be considered and should always be thoroughly evaluated when children present with a pheochromocytoma. Conversely, children with a familial syndrome should undergo annual screening for pheochromocytoma from a young age. Given the greater likelihood of a metachronous recurrence in children, consideration should be given to adrenal-sparing surgery in selected patients. When managed appropriately, the outlook for pheochromocytoma in children is excellent. Unfortunately, the uncommon malignant tumors are still difficult to treat. Perhaps the unique genetic characteristics of pheochromocytoma will ultimately be exploited in the management of the aggressive forms of this disease.
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Affiliation(s)
- J H Ross
- Section of Pediatric Urology, Cleveland Clinic Foundation, Ohio, USA
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28
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Affiliation(s)
- C Prys-Roberts
- Sir Humphry Davy Department of Anaesthesia, Bristol Royal Infirmary, UK
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29
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Sanjoaquín MT, Fraile JR, Gutiérrez A, Canal MI, Navia J. Hypertensive crisis during a transurethral resection of the bladder: nondiagnosed bladder paraganglioma. Anesth Analg 2000; 90:556-8. [PMID: 10702436 DOI: 10.1097/00000539-200003000-00011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M T Sanjoaquín
- Anesthesiology and Reanimation Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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30
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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: 58] [Impact Index Per Article: 2.4] [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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31
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Avila NA, Doppman JL, Walther MM, Keiser HR. Synchronous multicentric extraadrenal phaeochromocytoma: implications for management. Clin Radiol 1999; 54:772-4. [PMID: 10580770 DOI: 10.1016/s0009-9260(99)91182-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- N A Avila
- Diagnostic Radiology Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892-1182, USA
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32
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Fujishima S, Abe I, Kaseda S, Koga T, Hirano H, Hamada T, Oniki H, Onoyama K, Fujishima M. Ambulatory blood pressure monitoring in diagnosing a pheochromocytoma of the urinary bladder. A case report. Angiology 1997; 48:655-8. [PMID: 9242165 DOI: 10.1177/000331979704800714] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A patient is presented in whom the preoperative diagnosis of an intravesical pheochromocytoma was facilitated by noninvasive ambulatory blood pressure monitoring. A fifty-two-year-old Japanese man suffered headache and palpitation after micturition. Cystoscopy revealed an intravesical tumor. To investigate whether his symptoms were associated with an elevation of blood pressure, the authors monitored his ambulatory blood pressure automatically for twenty-four hours. The patient was also instructed to activate the recording manually upon the onset of symptoms. As a result, elevations of blood pressure were apparent following micturition. The twenty-four-hour urinary excretion of norepinephrine was elevated on the day of the blood pressure monitoring. Pheochromocytoma was suspected and was confirmed by histopathologic studies following the operation. Thus, ambulatory blood pressure monitoring may be useful in detecting the transient hypertension induced by micturition, which can provide preoperative evidence of pheochromocytoma of the urinary bladder.
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Affiliation(s)
- S Fujishima
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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33
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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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