Paragangliomas of the head, neck, urinary bladder, and pelvis in a hypertensive woman

Paraganglioma (pheochromocytoma) of the urinary bladder: A systematic review with a diagnostic, management and treatment algorithm

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

Nine Pheochromocytomas in the Same Patient

A 37-year-old man presented with hypertension and elevated urine catecholamine. Ultrasound scanning revealed a solid tumour of the right adrenal gland and two solid tumours in the retroperitoneum. The findings were confirmed with computed tomography and abdominal angiography. At surgery only the tumour of the right adrenal gland was removed. The histopathologic diagnosis was pheochromocytoma. Postoperatively the symptoms and biochemistry were unchanged and the patient was referred for further treatment. At ultrasonography and abdominal aortography 6 remaining tumours were demonstrated. Surgery was performed and 8 pheochromocytomas were extirpated (3 were closely spaced small tumours in a conglomerate corresponding to one of the visualized tumour sites). On histopathologic examination no signs of invasive growth were found. The patient recovered completely. The blood pressure was still normal 2 1/2 years later. Angiography and non-invasive examination of the entire abdomen and pelvis should be routine when pheochromocytomas are searched for.

Incidental paraganglioma of the urinary bladder in a 66-year-old woman

A 66-year-old female patient was referred to drology department when a bladder mass was incidentally found on a transvaginal ultrasound scan. Cystoscopy revealed a small, smooth mass just above the trigone which appeared to be covered with normal urothelium. The histology from this growth after transurethral resection revealed a paraganglioma of the bladder. We will discuss the management of this case and literature review of this finding in this study.

Vaginal paraganglioma presenting as a pelvic mass

Paragangliomas are extra-adrenal neuroendocrine neoplasms derived from neural crest precursors. These tumors rarely arise from the female genital tract. Vaginal paragangliomas are extremely rare. We describe a case of vaginal paraganglioma managed with minimally invasive surgical techniques.

Paraganglioma of the vagina: report of a case, including immunohistochemical and ultrastructural findings

Paragangliomas are uncommon neoplasms of the female genital tract, with fewer than 15 reported cases arising from the uterus, ovary, vagina, and cervix. Three of these tumors presented in the vagina. This report describes the authors' experience with a paraganglioma of the vagina in a 24-year-old woman that presented as an asymptomatic mass. The histologic features in the initial biopsy proved again that the paraganglioma may be confused with other vascular neoplasms. The clinical course after the biopsy implied that this neoplasm had been awakened from its functionless dormancy.

Digital subtraction angiography in head and neck radiology

Intravenous digital subtraction angiography (IVDSA) was used to evaluate 44 patients with suspected otolaryngologic abnormalities. Sixteen had IVDSA for pulsatile tinnitus or suspected glomus tumor of the petrous bone. Nine patients were evaluated because of pulsatile neck masses, and 12 others had suspected tumors of the neck, face, and paranasal sinuses. Seven had IVDSA following head and neck trauma. The technique of examination is described. The current indications of IVDSA in head and neck radiology are discussed. It is concluded that IVDSA is a suitable substitute for conventional angiography for many otolaryngologic conditions and, because of its safety, can be used more liberally.

Paraganglioma of urinary bladder

The literature is reviewed and 2 new cases of paraganglioma of the urinary bladder, 1 malignant and 1 benign, are presented. One patient had no classic symptoms of vesical paraganglioma, and diagnosis was made postoperatively by means of light and electron microscopy. Differentiation between malignant and benign endocrine tumor cannot be made histopathologically and biochemically. The preoperative diagnosis of bladder paraganglioma is established when there is a combination of atypical urinary symptoms and elevation of catecholamines in the urine or blood. The risk of dangerous vasomotor changes needs a multi-team approach for diagnosis and surgical treatment. The pathologic features, histochemical reactions, ultrastructural characteristics, histogenesis, methods for early diagnosis, and detection of multiple localizations or metastasis are briefly discussed. A precise family history should be obtained in any patient with an extra-adrenal paraganglioma to facilitate early diagnosis of tumors in previously unaffected family members or of additional tumors in affected relatives.

Primary vesical pheochromocytoma

Pheochromocytoma of the urinary bladder is a rare neoplasm that often occurs with the unique symptom complex of micturitional attacks due to increased catecholamine secretion during detrusor activity. Analysis of 3 of our patients is added to a discussion of 97 cases reported in the world literature. Therapeutic decision is complicated by the absence of unequivocal histologic criteria of malignancy for these tumors. Future perspectives in determining the malignant potential of pheochromocytoma are presented and our treatment plan elaborated.