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Orsini A, Ferretti S, Tamborino F, Cicchetti R, Ciavarella D, Seccia B, Basilico R, Colasante A, Marchioni M, Schips L. Mastering bladder paraganglioma for optimal treatment: a case report of robot-assisted surgery. Ther Adv Urol 2024; 16:17562872241249603. [PMID: 38779495 PMCID: PMC11110518 DOI: 10.1177/17562872241249603] [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: 02/01/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024] Open
Abstract
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.
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Affiliation(s)
- Angelo Orsini
- Department of Urology, SS Annunziata Hospital, ‘G. D’Annunzio’ University of Chieti, Via dei Vestini, Chieti, Italy
| | - Simone Ferretti
- Department of Medical, Oral and Biotechnological Sciences, ‘G. d’Annunzio’ University of Chieti, Urology Unit, Chieti, Italy
| | - Flavia Tamborino
- Department of Medical, Oral and Biotechnological Sciences, ‘G. d’Annunzio’ University of Chieti, Urology Unit, Chieti, Italy
| | - Rossella Cicchetti
- Department of Medical, Oral and Biotechnological Sciences, ‘G. d’Annunzio’ University of Chieti, Urology Unit, Chieti, Italy
| | - Davide Ciavarella
- Department of Medical, Oral and Biotechnological Sciences, ‘G. d’Annunzio’ University of Chieti, Urology Unit, Chieti, Italy
| | - Barbara Seccia
- Department of Neuroscience, Imaging and Clinical Sciences, ‘G. d’Annunzio’ University of Chieti, Chieti, Italy
| | - Raffaella Basilico
- Department of Medical, Oral and Biotechnological Sciences, ‘G. d’Annunzio’ University of Chieti, Radiology Unit, Chieti, Italy
| | | | - Michele Marchioni
- Department of Urology, SS Annunziata Hospital, ‘G. D’Annunzio’ University of Chieti, Via dei Vestini, Chieti 66100, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, ‘G. d’Annunzio’ University of Chieti, Urology Unit, Chieti, Italy
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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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3
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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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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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5
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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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6
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Katiyar R, Dwivedi S, Trivedi S, Patne SCU, Dwivedi US. Non-Functional Paraganglioma of the Urinary Bladder Treated by Transurethral Resection: Report of Two Cases. J Clin Diagn Res 2016; 10:XD01-XD03. [PMID: 27042569 DOI: 10.7860/jcdr/2016/17953.7219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/05/2016] [Indexed: 11/24/2022]
Abstract
Paraganglioma of the urinary bladder is a rare tumour derived from chromaffin tissue of the sympathetic nervous system. Paraganglioma of the urinary bladder especially the non-functional type is often misdiagnosed as urothelial cancer. Two female patients aged 32 years and 45 years presented with painless haematuria without any symptoms of catecholamine excess. Radiological investigations revealed urinary bladder tumour. The tumour was removed by transurethral resection in both the patients. Histopathological diagnosis was paraganglioma, which was confirmed by immunohistochemistry. Complete resection of tumour by transurethral approach is curative in paraganglioma of the urinary bladder. We hereby, also discuss the salient features of nonfunctional paraganglioma of the urinary bladder.
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Affiliation(s)
- Richa Katiyar
- Service Senior Resident, Department of Pathology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, (U.P.), India
| | - Saloni Dwivedi
- Junior Resident, Department of Pathology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, (U.P.), India
| | - Sameer Trivedi
- Associate Professor, Department of Urology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, (U.P.), India
| | - Shashikant C U Patne
- Assistant Professor, Department of Pathology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, (U.P.), India
| | - Uday Shankar Dwivedi
- Professor and Head, Department of Urology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, (U.P.), India
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7
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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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8
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Wong EMH, Lai TCT, Tsu JHL, Yee CH, Fan CW, Cheung FK, Ng CF, Yiu MK. Primary paraganglioma of urinary bladder: Case series and review of the literature. SURGICAL PRACTICE 2015. [DOI: 10.1111/1744-1633.12069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Chi-Hang Yee
- Department of Surgery; Chinese University of Hong Kong; Hong Kong
| | - Chi-Wai Fan
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong
| | - Fu-Keung Cheung
- Department of Surgery; Princess Margaret Hospital; Hong Kong
| | - Chi-Fai Ng
- Department of Surgery; Chinese University of Hong Kong; Hong Kong
| | - Ming-Kwong Yiu
- Department of Surgery; University of Hong Kong; Hong Kong
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9
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Henderson SJ, Kearns PJ, Tong CMC, Reddy M, Khurgin J, Bickell M, Miick R, Ginsberg P, Metro MJ. Patients With Urinary Bladder Paragangliomas: A Compiled Case Series From a Literature Review for Clinical Management. Urology 2015; 85:e25-9. [DOI: 10.1016/j.urology.2014.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 10/02/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
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10
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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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11
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Ahn SG, Jang H, Han DS, Lee JU, Yuk SM. Transurethral resection of bladder tumour (TURBT) as an optional treatment method on pheochromocytoma of the urinary bladder. Can Urol Assoc J 2013; 7:E130-4. [PMID: 23671503 DOI: 10.5489/cuaj.255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pheochromocytoma of the urinary bladder is rare. We have experienced a case of unexpected pheochromocytoma of the urinary bladder in a 45-year-old female. An ultrasonographic, computed tomography scan and cystoscopic examination showed a submucosal bladder mass. After transurethral resection of bladder tumour was performed, the bladder mass was confirmed as pheochromocytoma by a pathologist. After surgery, the patient underwent a subsequent pelvic magnetic resonance imaging, positron emission tomography and I(131)-methyliodobenzylguanidine (I(131)-MIBG). An image study showed no residual tumour sites and no lymphatic metastasis. The patient has had no tumour recurrence and no voiding symptoms 3 years after the surgery.
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Affiliation(s)
- Sun Gook Ahn
- Departments of Hospital Urology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
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12
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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: 93] [Impact Index Per Article: 8.5] [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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13
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Yang Y, Wei ZT, Lu JS, Zu Q, Wang H, Zhang X. Transurethral partial cystectomy with 2 μm thulium continuous wave laser in the treatment of bladder pheochromocytoma. J Endourol 2011; 26:686-90. [PMID: 22007839 DOI: 10.1089/end.2011.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To introduce transurethal partial cystectomy with a 2013 nm thulium laser as a treatment for paraganglioma of the urinary bladder in adults. PATIENTS AND METHODS Three patients with pheochromocytomas were treated transurethrally with a 2013 nm thulium laser under general anesthesia. A 2013 nm thulium laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between the detrusor muscle layer and outer connective tissues. Tumors with full-thickness detrusor muscle layers at the base were removed together. Intraoperative fluctuation of blood pressure, preoperative values of 24-hour urine catecholamine (CA) and vanillylmandelic acid (VMA), and postoperative complications were observed, and postoperative followtwoups were performed. RESULTS All operations were successful. Operative time was 25 to 32 minutes. Perioperative blood pressure was stable in two cases while blood pressure fluctuated in the third case. When the entire tumor and the full-thickness bladder wall at the base were freed, blood pressure reverted to stability. All values of 24-hour urine CA and VMA were within normal limits postoperatively. Patients were followed for 7 to 9 months postoperatively with no recurrence. This series included highly selected patients who were treated by a single senior surgeon who is rich in experience in performing 2013 nm thulium laser procedures. CONCLUSIONS To our knowledge, this is the first report of a 2013 nm thulium laser used to treat bladder pheochromocytoma. It can be applied to precisely vaporize and incise the full-thickness bladder wall and cut down the blood supply of the tumor, then peel it while blood pressure remains stable, thus completing partial cystectomy for bladder pheochromocytoma safely.
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Affiliation(s)
- Yong Yang
- Department of Urology, PLA General Hospital, Beijing, China.
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14
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Abstract
This study describes a case of urinary bladder pheochromocytoma that presented with paraneoplastic manifestation of bowel symptoms and thrombocytosis managed with laparoscopic techniques. Pheochromocytoma of the urinary bladder is rare, presenting usually with hypertension, hematuria and syncopal attacks. Such cases have usually been managed with open or laparoscopic partial cystectomy. We present a case of bladder pheochromocytoma that had unusual presenting symptoms, a paraneoplastic manifestation and was successfully managed with robotic technique.
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Affiliation(s)
- Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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15
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Liu Y, Dong SG, Dong Z, Mao X, Shi XY. Diagnosis and treatment of pheochromocytoma in urinary bladder. J Zhejiang Univ Sci B 2007; 8:435-8. [PMID: 17565515 PMCID: PMC1879157 DOI: 10.1631/jzus.2007.b0435] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study the diagnosis and treatment of pheochromocytoma in urinary bladder. METHODS Six cases of bladder pheochromocytoma were studied. Four cases showed hypertension, 3 of which were paroxysmal hypertension during urination. Catecholamine (CA) was increased in a case, and vanillymandelic acid (VMA) was increased in 2 cases. Bladder submucosal mass was detected by B-ultrasound in 5 cases (5/5), computerized tomography (CT) in 3 cases (3/3), cystoscopy in 5 cases (5/6). Four cases took alpha-receptor blocker for 2 weeks, 1 case took beta-receptor blocker to decrease heart rate. All patients were treated with surgical operation including 4 partial cystectomies, 2 excavations. RESULTS Three cases had manifestations including headache, excessive perspiration and hypertension during cystoscopy. Four cases were confirmed before operation. Two cases showed hypertension during operation. All patients were pathologically diagnosed as pheochromocytoma postoperatively. In five cases followed up, blood pressure returned to normal. No patient had relapse and malignancy. CONCLUSIONS Typical hypertension during urination comprised the main symptoms. We should highly suspect bladder pheochromocytoma if a submucosal mass was discovered with B-ultrasound, CT, (131)I-MIBG (methyliodobenzylguanidine) and cystoscopy. The determination of CA in urine is valuable for qualitative diagnosis. The preoperative management of controlling blood pressure and expansion of the blood volume are very important. Surgical operation is a good method for effective treatment. Postoperative long-time followed up is necessary.
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16
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Pastor-Guzmán JM, López-García S, Giménez-Bachs JM, Ruíz-Mondejar R, Cañamares-Pabolaza L, Atiénzar-Tobarra M, Casado-Moragón L, Virseda-Rodriguez JA. Paraganglioma of the Bladder: Controversy regarding Treatment. Urol Int 2004; 73:270-5. [PMID: 15539850 DOI: 10.1159/000080841] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2003] [Accepted: 12/20/2003] [Indexed: 11/19/2022]
Abstract
Paragangliomas or extra-adrenal pheochromocytomas account for approximately 15% of all pheochromocytomas. They are usually found in an intradiaphragmatic location. Paragangliomas of the urinary bladder are infrequent and represent 6% of the paragangliomas and 0.06% of all bladder tumors. We describe 2 cases of urinary bladder paragangliomas attended to our center and review the literature with special attention to treatment, since there is some controversy around the management of these tumors. Surgical options include partial or total cystectomy and transurethral resection, but there is no consensus regarding these treatment modalities. The 2 patients presented underwent transurethral resection with a good outcome and no recurrence or residual disease.
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17
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Benchekroun A, el Alj HA, Essayegh H, Zannoud M, Lachkar A, Marzouk M, Faik M. [Bladder paraganglioma (pheochromocytoma): report of a new case]. ACTA ACUST UNITED AC 2003; 37:264-6. [PMID: 14606315 DOI: 10.1016/s0003-4401(03)00042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The authors report one case of vesical paraganglioma, not suspected in a 50-years-old female patient who presented gross hematuria as only symptom. The patient was not hypertensive. Radiologic and endoscopic investigations revealed a trigonal submucosal tumour. Complete transurethral resection of the tumor was performed with no intraoperative complications. The histopathological diagnosis indicated pheochromocytoma. Blood pressure was stable. There has been no recurrence for 18 months after transurethral resection.
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Affiliation(s)
- A Benchekroun
- Service d'urologie A, centre hospitalier universitaire Ibn Sina, 27, rue Patrice-Lumumba, appartement 65, Rabat, Maroc
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Onishi T, Sakata Y, Yonemura S, Sugimura Y. Pheochromocytoma of the urinary bladder without typical symptoms. Int J Urol 2003; 10:398-400. [PMID: 12823696 DOI: 10.1046/j.1442-2042.2003.00645.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pheochromocytoma of the urinary bladder is an unusual tumor that typically presents with hypertensive crises related to micturition. We report, herein, the case of a 62-year-old woman with bladder pheochromocytoma. The patient presented with a bladder tumor that was incidentally found by computed tomography (CT) without the triad of sustained hypertension, hematuria and postmicturitional syncope. Cystoscopy revealed a yellowish submucosal tumor in the right lateral wall of the bladder. Treatment consisted of transurethral resection in the initial diagnosis of bladder tumor. A definitive diagnosis was made postoperatively upon pathological examination. The patient has been followed up for 12 months and has shown no recurrence.
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Affiliation(s)
- Takehisa Onishi
- Department of Urology, Prefectural Shima Hospital, Shima, Japan.
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19
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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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20
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Combined laparoscopic and transurethral partial cystectomy for juxta-ureteral pheochromocytoma of the bladder. MINIM INVASIV THER 2002; 11:19-22. [PMID: 16754042 DOI: 10.1080/136457002317255045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
An 18-year-old boy with a 2.5 cm by 3 cm pheochromocytoma involving the posterior wall of the bladder just above the interureteric bar was successfully treated by partial cystectomy, using a combined transurethral and laparoscopic approach. Although laparoscopic excision of pheochromocytoma on the anterior wall of the bladder has previously been reported, this is the first case where a laparo-endoscopic approach was used for a difficult posterior wall juxta-ureteral tumour.
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