DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20221193

Urinary bladder paraganglioma: a clinical dilemma in diagnosis and management: our experience at a tertiary care center

Akshay Kriplani, Deep Jain, Mayank Kulshreshtha, Suraj Jayadeva Reddy, Shruti Pandit, Bathi Sourabh Reddy, Gurvansh Singh Sachdev, Vivekanand Kedarlingayya Hiremath, Arun Chawla

Abstract


Urinary bladder paraganglioma (UBP) are rare neuroendocrine tumors with variable biological behavior. High index of suspicion in the preoperative evaluation would enable the clinician to formulate appropriate management of the rare tumors. Clinical and pathological data of seven cases evaluated and treated as per a devised protocol for suspected bladder paraganglioma from 2008 to 2019 was retrospectively reviewed. Among the seven cases, UBP’s were predominantly seen in middle aged men. Most of these presented with storage symptoms (85.71%; n=7) and gross painless hematuria (42.85%; n=3). Three patients were hypertensives and post-micturition syncope was seen in two patients. Among the seven patients two patients had functionally active tumors confirmed by elevated urinary and serum markers for catecholamine excess. Functional tumors, nonfunctional tumors involving uretero-vesical junction or broad based polypoidal tumor were considered for partial cystectomy. Other small nonfunctional tumors underwent trans-urethral resection of bladder tumour (TURBT). Follow up protocol included repeat ultrasound, check cystoscopy and completion TURBT at one month and annually thereafter. Repeat urinary catecholamines at 1 month was done in functional UBP. Cystoscopic examination of a bladder lesion which are solid, sessile and predominantly intramural, a prior to a definitive planned surgery may differentiate UBP from urothelial cancer. Most of the non-functional UPB are diagnosed by histopathological examination.  In symptomatic cases, functional evaluation with biochemical estimation of catecholamine excess allow better treatment planning and avoiding intraoperative hemodynamic instability. Due to high recurrence rate life-long follow-up despite complete excision is strongly recommended.


Keywords


Bladder paraganglioma, TURBT, Partial cystectomy, Histopathology

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References


Priyadarshi V, Pal DK. Paraganglioma of urinary bladder. Urol Ann. 2015;7(3):402-4.

Monappa V, Jaiprakash P. Bladder paraganglioma- A report of two cases. African J Urol. 2018;24:70-2.

Ranaweera M, Chung E. Bladder paraganglioma: A report of case series and critical review of current literature. World J Clin Cases. 2014;2(10):591-5.

Kappers MH, Meiracker AH, Alwani RA, Kats E, Baggen MG. Paraganglioma of the urinary bladder. Neth J Med. 2008;66(4):163-5.

Vyas S, Kalra N, Singh SK, Agarwal MM, Mandal AK, Khandelwal N. Pheochromocytoma of urinary bladder. Indian J Nephrol. 2011;21(3):198-200.

Baez JC, Jagannathan JP, Krajewski K, O'Regan K, Zukotynski K, Kulke M, et al. Pheochromocytoma and paraganglioma: imaging characteristics. Cancer Imaging. 2012;12(1):153-62.

Chang YK, Chiang NI, Chen CH, Wang SM. Paragangliomas of the urinary bladder: A report of 6 cases and review of the literature. Urological Sci. 2015;26:111.

Menon S, Goyal P, Suryawanshi P, Tongaonkar H, Joshi A, Bakshi G, et al. Paraganglioma of the urinary bladder: a clinicopathologic spectrum of a series of 14 cases emphasizing diagnostic dilemmas. Indian J Pathol Microbiol. 2014;57(1):19-23.

Lee KY, Oh YW, Noh HJ, Lee YJ, Yong HS, Kang EY, et al. Extraadrenal paragangliomas of the body: imaging features. AJR Am J Roentgenol. 2006;187(2):492-504.

Deng JH, Li HZ, Zhang YS, Liu GH. Functional paragangliomas of the urinary bladder: a report of 9 cases. Chin J Cancer. 2010;29(8):729-34.

Ranaweera M, Chung E. Bladder paraganglioma: A report of case series and critical review of current literature. World J Clin Cases. 2014;2(10):591-5.

Loveys FW, Pushpanathan C, Jackman S. Urinary Bladder Paraganglioma: AIRP Best Cases in Radiologic-Pathologic Correlation. Radiographics. 2015;35(5):1433-8.

Young WF. Paragangliomas: clinical overview. Ann N Y Acad Sci. 2006;1073:21-9.

Cheng L, Leibovich BC, Cheville JC, Ramnani DM, Sebo TJ, Neumann RM, et al. Paraganglioma of the urinary bladder: can biologic potential be predicted? Cancer. 2000;88(4):844-52.

Quist EE, Javadzadeh BM, Johannesen E, Johansson SL, Lele SM, et al. Malignant paraganglioma of the bladder: a case report and review of the literature. Pathol Res Pract. 2015;211(2):183-8.

Vassilatou E, Argeitis J, Nika H, Grapsa D, Smyrniotis V, Pafiti A. Malignant paraganglioma of the urinary bladder in a 44-year-old female: clinicopathological and immunohistochemical study of a rare entity and literature review. Eur J Gynaecol Oncol. 2007;28(2):149-51.

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(6):435-8.

Tsai CC, Wu WJ, Chueh KS, Li WM, Huang CH, Wu CC, et al. Paraganglioma of the urinary bladder first presented by bladder bloody tamponade: two case reports and review of the literatures. Kaohsiung J Med Sci. 2011;27(3):108-13.

Tsai SY. Bladder pheochromocytoma: a case report. Urol Sci. 2004:15.

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.

Zhou M, Epstein JI, Young RH. Paraganglioma of the urinary bladder: a lesion that may be misdiagnosed as urothelial carcinoma in transurethral resection specimens. Am J Surg Pathol. 2004;28(1):94-100.

Kurose H, Ueda K, Uegaki M, Ogasawara N, Kumagae H, Chikui K, et al. Paraganglioma of the urinary bladder: Case report and literature review. IJU Case Rep. 2020;3(5):192-5.

Sunil VN, John K, Nawahirsha S, Iyyadurai R. Micturition syncope: a rare presentation of bladder paraganglioma. BMJ Case Rep. 2020;13(9):235353.

Male M, Ye T, Tao J, Chen ZQ, Peng E. Differentiating Nonfunctional Paraganglioma of the Bladder from Urothelial Carcinoma of the Bladder: Pitfalls and Breakthroughs. Biomed Res Int. 2019;2019:1097149.