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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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Yuan Y, Su Z, Zhu R, Li X, Xu G. Bladder Paraganglioma: Three Cases Report and Literature Review. Int Med Case Rep J 2021; 14:765-771. [PMID: 34803407 PMCID: PMC8594893 DOI: 10.2147/imcrj.s336659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/16/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Bladder paraganglioma (BPG) is one of the rare neuroendocrine neoplasms that develops from neural crest cells. It categorizes into functional and non-functional types based on the catecholamines secretion. Currently, functional BPG is predicted in advance based on signs and symptoms of catecholamine excess, such as hypertension and "micturition attacks". However, it is often overlooked because of its rareness. Misdiagnosis of a functional tumor may increase the risk of surgical intervention. CASE PRESENTATION We reported 3 cases of BPG that they were admitted to the hospital due to abdominal pain or gross hematuria. Computed tomography (CT) scans showed space-occupying lesions in the bladders with diameters less than 3cm. There were no typical catecholamine excess symptoms before surgical intervention. Postoperative pathology confirmed BPG after removal of the tumor. We also analyze 69 cases of BPG that has been reported and found that 78.0% cases were functional among the tumors larger than 3cm. CONCLUSION Bladder tumors larger than 3cm in diameter can serve as an additional predictor of functional BPG. Patients who are suspected should undergo magnetic resonance imaging (MRI) scans, 123/131 metaiodobenzylguanidine (MIBG) scan, and have their catecholamine levels tested. Once the diagnosis is confirmed, patients should be started on fluid replacement therapy and adrenergic blockade to abate the disorders associated with catecholamine excess.
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Affiliation(s)
- Yaoji Yuan
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
- Key Laboratory of Enhanced Recovery After Abdominal Surgery, Guangzhou, Guangdong, People’s Republic of China
| | - Zhengming Su
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
- Key Laboratory of Enhanced Recovery After Abdominal Surgery, Guangzhou, Guangdong, People’s Republic of China
| | - Rui Zhu
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
- Key Laboratory of Enhanced Recovery After Abdominal Surgery, Guangzhou, Guangdong, People’s Republic of China
| | - Xiezhao Li
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
- Key Laboratory of Enhanced Recovery After Abdominal Surgery, Guangzhou, Guangdong, People’s Republic of China
| | - Guibin Xu
- Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
- Key Laboratory of Enhanced Recovery After Abdominal Surgery, Guangzhou, Guangdong, People’s Republic of China
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Tu X, Zhang N, Zhuang X, Chen S, Luo X. Incidental diagnosis of nonfunctional bladder paraganglioma: a case report and literature review. BMC Urol 2021; 21:98. [PMID: 34238271 PMCID: PMC8265019 DOI: 10.1186/s12894-021-00863-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 06/24/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nonfunctional bladder paragangliomas is a rare urological disease. It may present clinical, radiology and pathological features similar to bladder cancer, Only scarce reports have been reported. Urologist must identify this generally benign neuroendocrine neoplasm to avoid misdiagnosis. CASE PRESENTATION A 62-year-old female presented the outpatient department of our hospital with the symptoms of stomachache, frequent micturition, and urination pain for 20 days. Diagnosed with high blood pressure 1 year ago, administered Amlodipine besylate tablets 5 mg po qd occasionally, did not check blood pressure; denied any tumor observation in the family history. Color ultrasound of the urinary system showed a 38 mm × 34 mm hypoechoic mass on the right side of the bladder, CDFI: in the masses, blood supply was sufficient. Cystoscope showed bladder occupying lesion. Biopsy diagnosis: papillary polypoid cystitis was suspected as a malignant change (Fig. 3a). Then, the patient was admitted to our urological department. Further, computer tomography urography considered bladder cancer. Cystoscopy and biopsy failed to define the nature of the lesions in our outpatient department, which prompted a transurethral resection of the bladder tumor. histopathological and immunohistochemical results were diagnosed as bladder paragangliomas. For the reason, the tumor was removed by partial resection of the bladder. The postoperative recovery and follow-up were uneventful. CONCLUSIONS Nonfunctional bladder paragangliomas are occasionally found on imaging studies with the symptoms of urinary tract infection or/and intermittent painless hematuria. It may present clinical, radiology and pathological features similar to bladder cancer, so knowledge of this generally benign neuroendocrine neoplasm is of great importance to avoid misdiagnosis. It should be accompanied by the clinical and pathological characteristics of the patient and image changes. Partial resection of the bladder can effectively treat this disease.
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Affiliation(s)
- Xi Tu
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Neng Zhang
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Xiyao Zhuang
- Department of Internal Medicine, Chengdu Shuangliu Hospital of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shulian Chen
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Xu Luo
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.
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Li H, Xie J, Chen Z, Yang S, Lai Y. Diagnosis and treatment of a rare tumor-bladder paraganglioma. Mol Clin Oncol 2020; 13:40. [PMID: 32832083 DOI: 10.3892/mco.2020.2110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 07/17/2020] [Indexed: 12/25/2022] Open
Abstract
Bladder paragangliomas are very rare tumors that are often misdiagnosed. The present study retrospectively analyzed the clinical data and follow-up results of patients with bladder paraganglioma that were treated surgically in Peking University Shenzhen Hospital between 2012 and 2018, and reviewed the relevant literature. A total of 4 patients with bladder paraganglioma were treated surgically from 2012 to 2018. All patients were female with ages ranging from 28 to 54 years old (average, 47.25). A total of one patient exhibited micturition attacks and palpitations, and one other exhibited gross hematuria. A total of two patients exhibited while no obvious symptoms. One patient exhibited elevated plasma catecholamine, was well prepared with medicine and underwent partial cystectomy, and 3 patients were not successfully diagnosed with paraganglioma before surgery. These patients received transurethral resection and 2 had distinct blood pressure elevation during operation. After surgery, the patients were followed-up for 5-69 months, during which all had normal blood pressure and none experienced recurrence. Bladder paragangliomas exhibit a variety of clinical presentations, which can be nonspecific for the non-functional ones, therefore may easily lead to misdiagnosis. Surgeons must fully consider the possibility of this disease when dealing with non-epithelial bladder tumors. Surgical resection is an effective treatment. For cases successfully diagnosed before surgery, partial cystectomy should be a treatment priority.
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Affiliation(s)
- Hang Li
- Department of Urology, Institute of Urology, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST (Peking University, Hong Kong University of Science and Technology) Medical Center, Shenzhen, Guangdong 518036, P.R. China.,The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Jiaodi Xie
- Department of Urology, Institute of Urology, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST (Peking University, Hong Kong University of Science and Technology) Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Zebo Chen
- Department of Urology, Institute of Urology, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST (Peking University, Hong Kong University of Science and Technology) Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Shangqi Yang
- Department of Urology, Institute of Urology, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST (Peking University, Hong Kong University of Science and Technology) Medical Center, Shenzhen, Guangdong 518036, P.R. China
| | - Yongqing Lai
- Department of Urology, Institute of Urology, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST (Peking University, Hong Kong University of Science and Technology) Medical Center, Shenzhen, Guangdong 518036, P.R. China.,The Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
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Wang EY, Pak JS, Virk RK, Anderson CB, Healy KA, Lee JA, Benson MC, McKiernan JM. Bladder Preservation for Patients With Bladder Paragangliomas: Case Series and Review of the Literature. Urology 2020; 143:194-205. [PMID: 32437773 DOI: 10.1016/j.urology.2020.04.098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 12/27/2022]
Abstract
Bladder paragangliomas are rare tumors, with no prospective studies or guidelines on the management of this disease. We present a case series of 6 patients managed with bladder preservation over a median follow-up period of 124 months. We also present a review of the recent literature on bladder paragangliomas. We aim to provide a timely synthesis of the recent evidence on bladder paragangliomas as changing paradigms necessitate individualized treatment.
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Affiliation(s)
- Elizabeth Y Wang
- Department of Urology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY; Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
| | - Jamie S Pak
- Department of Urology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Renu K Virk
- Department of Pathology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Christopher B Anderson
- Department of Urology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Kelly A Healy
- Department of Urology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - James A Lee
- Department of Surgery, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - Mitchell C Benson
- Department of Urology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | - James M McKiernan
- Department of Urology, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
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Zhou J, Wu WF, Zhang W, Xin J, Lei WH. Successful transurethral resection of the prostate in ectopic prostate pheochromocytoma: A case report. Medicine (Baltimore) 2020; 99:e19852. [PMID: 32332642 PMCID: PMC7220695 DOI: 10.1097/md.0000000000019852] [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: 11/25/2022] Open
Abstract
INTRODUCTION Most pheochromocytomas of the urinary tract are located in the bladder. However, ectopic prostate pheochromocytomas have rarely been reported. We herein report an unusual case of ectopic prostate pheochromocytoma successfully treated by transurethral resection of the prostate (TURP). PATIENT CONCERNS A 44-year-old Asian man with no significant previous medical history such as hypertension, presented to the urologist complaining of palpitations and anxiety on urination for more than 1 month. DIAGNOSES Pathological examination confirmed ectopic prostate pheochromocytoma. INTERVENTIONS An ectopic prostate pheochromocytoma without definite metastasis was confirmed. The lesion was successfully treated via TURP. OUTCOMES All of his symptoms completely and immediately disappeared after surgery. Over a 21-month follow-up period, a repeat abdominal computed tomography (CT) scan did not show any evidence of recurrence. CONCLUSION When patients present with symptoms of catecholamine excess on urination, extra-adrenal pheochromocytoma in the prostate should also be considered. TURP may be a viable option for therapy.
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Affiliation(s)
- Jin Zhou
- Department of Urology, The first hospital of Quanzhou affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Wen-Feng Wu
- Department of Urology, The first hospital of Quanzhou affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Wenbin Zhang
- Department of Urology, The first hospital of Quanzhou affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Jun Xin
- Department of Urology, The first hospital of Quanzhou affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Wen-Hui Lei
- Department of Medicine, Lishui Municipal Central Hospital, Lishui, Zhejiang Province
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Mahjoubi Z, Ben Rhouma S, Bibi M, Sellami A, Taktak T, Zehani A, Mohamed Ali BC, Yassine N. Atypical calcified paraganglioma of the urinary bladder: A new case report. Urol Case Rep 2018; 20:108-110. [PMID: 30116717 PMCID: PMC6091226 DOI: 10.1016/j.eucr.2018.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/22/2018] [Accepted: 07/26/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
- Zied Mahjoubi
- Department of Urology, CHU Rabta, Tunis, Tunisia
- Corresponding author.
| | | | - Mokhtar Bibi
- Department of Urology, CHU Rabta, Tunis, Tunisia
| | | | - Tarek Taktak
- Department of Urology, CHU Rabta, Tunis, Tunisia
| | - Alia Zehani
- Department of Histopathology, CHU Rabta, Tunis, Tunisia
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