Pheochromocytoma of the urinary bladder.

Abstract

Dear Editor,A 44-year-old female presented with a 7-year history of par-oxysmal episodes of dyspnea, headache, palpitation, tremors, andhypertension. In each episode, there had been a sudden onset ofsymptoms, with no triggering factors, and spontaneous improve-ment after approximately 15 min. On physical examination, shepresented no relevant findings or comorbidities. At hospital ad-mission, she reported having had episodes of palpitation, tachy-cardia, and profuse post-micturition sweating, remaining asymp-tomatic between episodes. She was submitted to computed to-mography (CT) and magnetic resonance imaging (MRI), asshown in Figures 1A and 1B, respectively. The CT scan, withintravenous administration of contrast medium, revealed a nodu-lar lesion, measuring 3.5 × 3.0 cm, with lobulated contours andincreased density in its soft parts, showing intense, heterogeneousenhancement, in the anteroinferior wall of the bladder. On MRI,the lesion presented a lobular pattern, with a heterogeneous sig-nal on T2-weighted sequences, a predominance of isointense sig-nals, and foci of hyperintense signals in its center. Surgical resec-tion of the lesion (partial cystectomy) was performed. Examina-tion of the surgical specimen, retrieved from the right anteriorwall of the bladder, showed a yellowish tumor measuring 3.0 ×3.0 cm, with a macroscopic appearance similar to that of adrenaltissue (Figure 1C). The pathological examination of the speci-men revealed extra-adrenal paraganglioma and tumor-free mar-gins (Figure 1D). In the postoperative period and during the re-mainder of the hospital stay, the patient did not present any of theadrenergic symptoms previously reported.Pheochromocytomas are tumors of the sympathetic nervoussystem and can be functioning or nonfunctioning, sometimessecreting catecholamines, thus causing paroxysmal hypertension,palpitations, headache, and syncope