無功能性膀胱副神經節腫瘤之案例分享與文獻回顧

李翊維、蔡樹衛

國泰綜合醫院 外科部 泌尿科

Nonfunctional paraganglioma of bladder – A case report and literature review

Yi-Wei Lee, Shu-Wei Tsai

Division of Urology, Department of Surgery, Cathay General Hospital, Taipei City, Taiwan

Paraganglioma of the urinary bladder is a rare neuroendocrine tumor which originates from the chromaffin tissue of the sympathetic nervous system. It only accounts for about 0.05% of all vesical tumors. Bladder paraganglioma may also present with non-specific symptoms which could easily lead to misdiagnosis.

This is a 93-year-old woman with multiple systemic conditions, including: 1) heart failure with preserved ejection fraction (New York heart association classification IV), 2) coronary artery disease post percutaneous transluminal coronary angioplasty and stenting, 3) paroxysmal atrial fibrillation, 4) type 2 diabetes mellitus with hyperglycemia, 5) hypertension, 6) dyslipidemia. During hospitalization for cardiovascular issues, she experienced intermittent hematuria prompting a urology consultation for further evaluation. A review of her medical history that an abdominal contrast-enhanced computed tomography performed approximately 2 years ago prior showed a 2.1cm tumor on left posterior wall of bladder. At that time, she reported only urinary frequency and nocturia, which  she did not consider significant due to COVID-19 pandemic. After discontinuing her anti-platelet medication, intermittent hematuria was still noted. Bladder ultrasound revealed large amount of blood clot in the bladder causing bladder tamponade. Consequently, cystoscopy and transurethral resection of bladder tumor was performed. Pathological examination confirmed the tumor as paraganglioma. Immunohistochemistry revealed positive marker for Chromogranin A, GATA3, S-100, while AE1/AE3 and p63 were negative, supporting the diagnosis of bladder paraganglioma. The patient underwent a transurethral resection of the bladder tumor and recovered smoothly without any postoperative discomfort.

Bladder paraganglioma is easily misdiagnosed due to its non-specific symptoms, which can resemble other bladder conditions. This case aims to raise awareness of this rare condition and emphasizes the importance of considering bladder paraganglioma in patients presenting with similar symptoms.