林弋筑、蔡昇翰、張心湜

振興醫療財團法人振興醫院 泌尿部

Yi-Chu Lin, Sheng-Han Tsai, Shin-Shu Chang

Department of Urology, Cheng Hsin General Hospital, Taipei, Taiwan

The 46 year-old man was found bladder tumor by sonography during health examination, and he was referred to urology outpatient department (OPD). According to the patient’s statement, he had palpitation and headache during micturition in recent year, and hypertension was diagnosed recently. Urine cytology was negative, abdominal computed tomography(CT) showed a homogenous enhanced tumor about 3.5cm with lobulated contour between right posterior wall of urinary bladder and sigmoid colon, cystoscopy showed an intramural bladder tumor in posterior wall. According to the clinical symptoms and image finding, rare bladder tumor was suspected, catecholamine was checked for rule out paraganglioma and showed normal result. After discussion with the patient, he decided received partial cystectomy. During operation, systolic blood pressure would increase more than 180 mmHg when the tumor was manipulated. The bladder tumor was resected under close monitor and careful control of blood pressure. The final pathology report was bladder paraganglioma, a rare bladder tumor.

Paragangliomas are rare neuroendocrine tumors that arise from the extra-adrenal autonomic paraganglia, small organs consisting mainly of neuroendocrine cells that are derived from the embryonic neural crest and have the ability to secrete catecholamines. Sympathetic paragangliomas usually secrete catecholamines and are located in the sympathetic paravertebral ganglia of thorax, abdomen, and pelvis. In contrast, most parasympathetic paragangliomas are nonfunctional and located along the glossopharyngeal and vagal nerves in the neck and at the base of the skull. Catecholamine-secreting paragangliomas often present clinically like pheochromocytomas with hypertension, episodic headache, sweating, and tachycardia. In the genitourinary tract, the urinary bladder is the most common site for paragangliomas. Bladder paraganglioma consisted only 0.05% of all bladder tumors. According to literature, bladder paraganglioma had similar characteristic as pheochromocytoma, but high recurrence rated than pheochromocytoma, even with benign or small tumors. Thus, if bladder paraganglioma was highly suspected, especially with a large tumor size, partial or radical cystectomy with life-long follow-up is strongly recommended.