Bladder paragangliomas: a pictorial review

Unrecognised paraganglioma of the urinary bladder precipitating hypertensive crisis

Bladder paragangliomas (bPGLs) account for only 0.06% of all bladder tumours, most commonly presenting with post-micturition syncope and hypertensive crisis. Silent paragangliomas are very rare, and failure to recognise them in the perioperative setting can precipitate a hypertensive crisis in the absence of sufficient alpha-blockade. Here, we describe a case of unrecognised bPGL in a woman with pre-existing hypertension and a single prior episode of haematuria thought to be related to urothelial carcinoma. She was found to have a low-grade non-invasive papillary urothelial carcinoma (potentially the cause of her haematuria) and an unrelated vascular-appearing tumour causing hypertensive crisis and broad complex tachycardia on resection. This was confirmed to be a bPGL on histology for which she underwent definitive management with a partial cystectomy following blood pressure management.

Bladder paraganglioma: Case report and review of the literature

Pheochromocytoma is a tumor that originates from the chromaffin cells of the adrenal medulla and is responsible for the production of catecholamines. However, when it occurs outside the adrenal glands, it is called a paraganglioma and accounts for 10%-15% of cases. In this report, we present the case of a 27-year-old male patient with a history of hypertension, who presented hematuria and dizziness on urination with a diagnosis of bladder paraganglioma. Contrast-enhanced computed tomography revealed the presence of a bladder tumor. Bladder paraganglioma is a rare condition, and understanding possible imaging findings is crucial to raising suspicion of this diagnosis and expanding our knowledge of this rare disease.

Bladder Paraganglioma Presenting as Post-Micturition Palpitations: A Case Report

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.

Mastering bladder paraganglioma for optimal treatment: a case report of robot-assisted surgery

Bladder paraganglioma is a rare neuroendocrine neoplasm, either functional or non-functional, arising from the urinary bladder. Functional variants present with catecholamine-related symptoms, while non-functional variants pose diagnostic challenges, mimicking urothelial carcinoma. Misdiagnosis risks underscore the importance of accurate identification for appropriate patient management. In this case, a 52-year-old man, diagnosed incidentally with hypertension and reported occasional post-micturition tachycardia, underwent abdominal ultrasound for known hepatic cyst follow-up, revealing an oval hypoechoic bladder mass. Initial consideration of bladder urothelial carcinoma prompted further investigation with contrast-enhanced CT scan and cystoscopy that confirmed extrinsic mass nature, and subsequent robotic-assisted partial cystectomy was performed. Histologically, the removed mass exhibited characteristic features of bladder paraganglioma. Postoperative recovery was uneventful, with resolution of post-micturition tachycardia at 1 month. Follow-up includes endocrinological evaluation and a 6-month CT scan. In conclusion, bladder paraganglioma should be considered in para-vesical mass differentials. This case highlights the importance of meticulous history collection, even in asymptomatic patients, the need for a multidisciplinary approach for accurate diagnosis and management of this rare condition, and the robotic approach as a viable option.

Quantitative MRI in distinguishing bladder paraganglioma from bladder leiomyoma

PURPOSE

To investigate the feasibility of quantitative MRI in the differentiation of bladder paraganglioma from bladder leiomyoma.

METHODS

From 2014 to 2021, 11 patients with bladder paraganglioma and 14 patients with bladder leiomyoma confirmed by surgical pathology were retrospectively collected. All patients underwent multiparametric scanning with a 3.0 T MR system. Quantitative parameters including the SI-ratio on T₁WI between the solid component of tumours and piriformis, ADC value and E-rate of the solid component of tumours were assessed. Independent sample t test or Mann-Whitney U test was used to compare these parameters between the two groups. The diagnostic efficiency of the parameters was examined using ROC curve analysis and the DeLong test.

RESULTS

There were significant differences in SI-ratio on T₁WI (P < 0.001), ADC value (P = 0.002) and the E-rate (P = 0.040) between the paraganglioma group and the leiomyoma group. The cutoff value of SI-ratio on 3 leiomyoma was 1.241, and the AUC was 1.000 (0.858-1.000). The cutoff value of the ADC value was 0.979 × 10^-3mm²/s, and the AUC was 0.907 (0.717-0.987). The cutoff value of E-rate was 98.7%, and the AUC was 0.714 (0.495-0.878). The AUCs of the SI-ratio on T₁WI and ADC value were significantly higher than the E-rate AUC (P = 0.015 and 0.034, respectively).

CONCLUSION

Quantitative MRI can effectively distinguish bladder paraganglioma from bladder leiomyoma with the SI-ratio on T₁WI or ADC value.

Nonfunctional bladder paraganglioma misdiagnosed as hemangioma: A case report

BACKGROUND

Paraganglioma of the urinary bladder (PUB) is a nonepithelial tumor of the bladder that is also known as bladder pheochromocytoma. The incidence of nonfunctional paraganglioma of the urinary bladder is rare in clinical practice.

CASE SUMMARY

A case of nonfunctional paraganglioma of the urinary bladder diagnosed and treated in our hospital is reported herein. A 2.5 cm × 2.1 cm moderate-echo mass protruding into the right anterior wall of the bladder was incidentally found during transvaginal color Doppler ultrasound examination. Based on a contrast-enhanced computed tomography scan of the bladder, the right anterior wall of the bladder was considered to present a hemangioma. The patient underwent laparoscopic partial resection of the bladder wall in our hospital, and pathological results showed paraganglioma of the bladder. At present, we have followed up with the patient for half a year, and there has been no recurrence of the tumor.

CONCLUSION

The imaging patterns of PUB and bladder hemangioma are similar. In clinical practice, the possibility of PUB should be considered for a single wide-based isoechoic mass in the bladder, especially functional PUB may cause some adverse effects during surgery.