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Liang JP, Yin L, Gao LK, Yin L, Ren W, Jin ZF, Chen LP, Liu YY. Contrast-enhanced CT in the differential diagnosis of bladder cancer and paraganglioma. Abdom Radiol (NY) 2024; 49:1584-1592. [PMID: 38502213 DOI: 10.1007/s00261-024-04217-8] [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] [Received: 11/19/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE We sought to summarize the value of contrast-enhanced computed tomography (CECT) in the differential diagnosis of bladder paraganglioma (BPG) and bladder cancer. METHODS The medical records of 19 patients with BPG (13 males, 6 females) and 56 patients with bladder cancer (49 males, 7 females) between November 2007 and June 2023 were retrospectively reviewed. All patients underwent unenhanced and contrast-enhanced CT scanning. RESULTS Patient age (46.4 ± 11.1 years vs. 58.6 ± 16.0 years), tumor calcification (1/19 vs. 18/56), stalk (0/19 vs. 10/56), internal vessels (15/19 vs. 19/56) and the enlarged adjacent supplying artery (14/19 vs. 10/56) were significantly different between BPG and bladder cancer (P < 0.05). The CT value in the corticomedullary phase (92.4 ± 16.6 HU vs. 64.0 ± 14.5 HU) and the contrast-enhanced value in the corticomedullary phase (54.5 ± 17.4 HU vs. 28.5 ± 12.8 HU) were significantly greater in BPG patients than in bladder cancer patients (P < 0.001), with corresponding area under the curve values of 0.930 and 0.912, respectively. The optimal cutoff values were 83.2 HU and 38.5 HU, respectively. A CT value > 83.2 HU in the corticomedullary phase and a contrast-enhanced CT value > 38.5 HU in the corticomedullary phase were used to indicate BPG with sensitivities of 78.9% and 89.5%, respectively, and specificities of 94.6% and 75.0%, respectively. CONCLUSION The corticomedullary phase of CECT plays an important role in the preoperative differential diagnosis of BPG and bladder cancer.
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Affiliation(s)
- Jiu-Ping Liang
- Department of Radiology, Shenzhen Bao'an District Songgang People's Hospital, Shenzhen, 518105, China
- Department of Radiology, Shenzhen Baoan Hospital, Southern Medical University, Shenzhen, 518101, China
| | - Liang Yin
- Department of Radiology, Shenzhen Baoan Hospital, Southern Medical University, Shenzhen, 518101, China
| | - Li-Kun Gao
- Department of Pathology, The Second Affiliated Hospital, Jinan University, Shenzhen, 518100, China
| | - Lei Yin
- Department of Radiology, Provincial Clinical College, Fujian Medical University, Fuzhou, 350001, China
| | - Wang Ren
- Medical Imaging Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350001, China
| | - Zhi-Fa Jin
- Medical Imaging Center, The Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, 529070, China
| | - Li-Peng Chen
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, China
| | - Yi-Yong Liu
- Department of Radiology, Rehabilitation Hospital of China National Nuclear Corporation, Number 120 Jinjiang Road, Yuelu District, Changsha, 410017, Hunan Province, China.
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Zare A, Bighamian M, Moloudi F, Narouie B, Rouientan H. Bladder Paraganglioma Presenting as Post-Micturition Palpitations: A Case Report. Case Rep Oncol 2024; 17:484-489. [PMID: 38529343 PMCID: PMC10963052 DOI: 10.1159/000538073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Paraganglioma of the urinary bladder (PUB) is an extremely rare extra-adrenal catecholamine-secreting neuroendocrine tumor, accounting for only 0.05% of all bladder tumors and 1% of all pheochromocytomas. The clinical presentation of PUB can be diverse and challenging to diagnose. Case Presentation This case report presents a 37-year-old man with post-micturition palpitation, headache, and sweating, with no history of hematuria or other irritative urinary symptoms. Ultrasound and contrast-enhanced computed tomography revealed a suspicious mass in the right posterolateral wall of the urinary bladder. Despite normal functional hormonal tests, the diagnosis of PUB was confirmed after surgical enucleation and histopathological examination. Conclusion This report emphasizes the importance of considering PUB as a differential diagnosis in patients with post-micturition symptoms and paroxysmal hypertension, as well as the need for a multidisciplinary approach in the evaluation and management of such rare and complex cases. Early recognition and surgical intervention are crucial for optimal management and favorable clinical outcomes.
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Affiliation(s)
- Ali Zare
- Department of Urology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Moein Bighamian
- Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farzad Moloudi
- Department of Radiology, Urmia University of Medical Sciences, Urmia, Iran
| | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran
- Urology and Nephrology Research Center, Department of Urology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Rouientan
- Urology and Nephrology Research Center, Department of Urology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kita S, Yamakawa M, Kono R, Soumiya K, Atagi Y, Nakanishi S, Yanagihara Y, Ninomiya I, Okamoto K, Yamashi S, Kan M. [NONRISING BLADDER PARAGANGLIOMA SUCCESSFULLY TREATED BY THE OPEN BLADDER SURGERY: A CASE REPORT]. Nihon Hinyokika Gakkai Zasshi 2023; 114:16-20. [PMID: 38246621 DOI: 10.5980/jpnjurol.114.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The patient is a 47-year-old female. MRI revealed a well-defined submuscular mass in the bladder muscle layer. Bladder paraganglioma was suspected based on MRI findings. Endocrinologic Testing showed no significant elevation. 123I-MIBG scintigraphy of the mass showed a significant uptake, and we made diagnosis of bladder paraganglioma. The mass was nonrising and showed no color differentiation making its location undetectable. Using MRI with a ureteral stent and urethral catheter in place, we were able to determine its location. The possibility of damage to the ureteral or internal urethral opening was feared. We chose open bladder surgery, emphasizing ease of operation and visualization. Although a transient increase in blood pressure was observed during the operation, the mass was resected as a single mass from all layers of the bladder without damaging the ureteral or internal urethral opening. Histopathological examination revealed a paraganglioma.MRI (ureteral stent and urethral catheter placement) and open bladder surgery were useful for identifying the location and resecting this case of this otherwise undetectable bladder paraganglioma.
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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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Zhu X, Zhou M, Yu H, Kuang Y, Chen Y, Li H, Gou X. Bladder paraganglioma managed with transurethral holmium laser resection: A case report. Medicine (Baltimore) 2021; 100:e26909. [PMID: 34449457 PMCID: PMC8389942 DOI: 10.1097/md.0000000000026909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Bladder paraganglioma is characterized by headache, palpitations, hypertension, blurred vision, or sweating during voiding. Transurethral holmium laser resection is a safe and efficacious alternative method for the resection of bladder neoplasms. PATIENT CONCERNS A 24-year-old female had a 2-year history of intermittent headaches, palpitation, and sweating during micturition. DIAGNOSIS Physical examination revealed a rise in the patient's blood pressure to 180/90 mmHg after micturition. Laboratory examination found that the blood catecholamine metabolites were significantly increased. Abdominal ultrasound and computed tomography (CT) scan indicated a 37 mm × 31 mm paraganglioma situated at the right anterolateral wall of the bladder. A diagnosis of bladder paraganglioma was considered based on a comprehensive evaluation of the physical examination, laboratory examination, ultrasound and computerized tomography scan. INTERVENTIONS Preoperative oral administration of a nonselective α-adrenergic receptor antagonist (phenoxybenzamine, 10 mg three times a day,) accompanied by a high-sodium diet and generous fluid intake, was initiated 2 weeks before the surgery to stabilize intraoperative hemodynamics. As the patient was newly married and nulligravid, management with transurethral resection was considered superior to open or partial cystectomy and was selected as the treatment method. OUTCOMES Transurethral holmium resection of the bladder paraganglioma was successfully performed with blood loss less than 20 ml and well-controlled intraoperative blood pressure. The 1-year follow-up results demonstrated well-controlled symptoms. Cystoscopy and evaluation of blood catecholamine metabolites revealed no disease recurrence. LESSONS Transurethral holmium laser resection is a good alternative approach for the resection of bladder paraganglioma, given its advantages of safety and efficacy.
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Affiliation(s)
| | - Mi Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University
| | | | | | | | - Heqiu Li
- Department of Pathology, Molecular Medicine Testing Center, Chongqing Medical University, Chongqing, China
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Ko A, Ezzeldin O, Bezold S, Bhargava P. Metastatic urinary bladder paraganglioma on Ga-68 DOTATATE PET/CT. Radiol Case Rep 2021; 16:2763-2767. [PMID: 34367391 PMCID: PMC8326565 DOI: 10.1016/j.radcr.2021.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/20/2021] [Accepted: 06/26/2021] [Indexed: 11/15/2022] Open
Abstract
Paragangliomas are extra-adrenal catecholamine-secreting neuroendocrine tumors that can present with adrenergic signs and symptoms. The urinary bladder is a rare location for a paraganglioma, and these tumors must be distinguished from other more common bladder neoplasms. In this case report, we discuss a 59 year-old woman who initially presented with tachycardia, palpitations, chest tightness, shortness of breath, and weight loss. Laboratory evaluation showed significantly elevated catecholamines in the plasma and urine. A CT (Computed Tomography) scan of the abdomen and pelvis revealed an enhancing mass arising from the urinary bladder and an enlarged right pelvic lymph node. A follow up Ga-68 DOTATATE PET/CT (Positron Emission Tomography and/or Computed Tomography) showed increased uptake in the primary bladder mass, right pelvic lymph node, numerous skeletal lesions, and pulmonary nodules, consistent with metastatic paraganglioma of the urinary bladder. This case report demonstrates the radiological findings of metastatic urinary bladder paraganglioma and highlights the importance of skull base to mid-thigh PET/CT using Ga-68 DOTATATE. It is crucial for the radiologist to be familiar with the characteristics of urinary bladder paragangliomas and identify these tumors on imaging to allow prompt initiation of surgical resection and/or systemic therapy.
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Affiliation(s)
- Andrew Ko
- Department of Radiology, University of Texas Medical Branch, Galveston, TX, 77555
| | - Obadah Ezzeldin
- Department of Radiology, University of Texas Medical Branch, Galveston, TX, 77555
| | - Samuel Bezold
- Department of Radiology, University of Texas Medical Branch, Galveston, TX, 77555
| | - Peeyush Bhargava
- Department of Radiology, University of Texas Medical Branch, Galveston, TX, 77555
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Patel S, Hamad J, Nielsen ME, Johnson S. Management and evaluation of bladder paragangliomas. Asian J Urol 2021; 9:94-96. [PMID: 35198402 PMCID: PMC8841279 DOI: 10.1016/j.ajur.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/20/2021] [Accepted: 03/14/2021] [Indexed: 11/26/2022] Open
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