Paraganglioma of the Urinary Bladder

Abstract

Urinary bladder paragangliomas are rare with a reported incidence of <1% of bladder tumors. We presented a case of a urinary bladder paraganglioma in a 26-year-old male who presented with a painless gross hematuria and hypertensive crisis occurring during his trans-urethral resection. Our diagnosis was based upon patient’s history, abdominal-pelvic computed tomography scan, which revealed a left-sided bladder wall mass 2.26 X 4.4 X 3.28 cm that was obstructing the left distal ureter and causing significant left severe hydroureter and hydronephrosis. Preoperative preparation was done with beta blocker and alpha blocker two weeks prior to surgery. The patient underwent an open surgical partial cystectomy, left nephroureterectomy and, complete external and internal iliac lymphadenectomy. Gross pathological examination of the mass revealed a 3x4.5x4 cm growth originating from the wall of the urinary bladder. Microscopic examination revealed nests invaded into muscularis propria of the urinary bladder, with no evidence of distant metastasis. Immunohistochemical studies showed positive tumor cells staining for chromogranin and synaptophysin while S100 highlighted the surrounding sustentacular cells. During the first 3-month post-operative follow-up period, the patient’s blood pressure was stabilized and the symptoms gradually subsided. Urinary bladder paragangliomas should be considered among the differential diagnosis of bladder tumors.