[Pheochromocytoma with multiple localizations manifested by a hemorrhagic bladder tumor]

Area of Science:

• Endocrinology
• Urologic Oncology
• Surgical Pathology

Background:

• Pheochromocytoma, an endocrine tumor from neuroectodermal tissue, typically arises in adrenal glands.
• Extra-adrenal pheochromocytomas can occur in various locations.
• Hematuria can be a presenting symptom of genitourinary tumors.

Observation:

• A case of pheochromocytoma originating in the bladder presented with hematuria.
• Initial surgical removal of the bladder tumor was performed via partial cystectomy.
• Post-operative persistent biologic disorders, including elevated catecholamines, vanillylmandelic acid, and metanephrines, were noted.

Findings:

• The persistent symptoms indicated a concurrent or missed adrenal pheochromocytoma.
• A subsequent adrenal pheochromocytoma was diagnosed and surgically excised.
• Complete resolution of biologic disorders and recovery followed the adrenal tumor removal.

Implications:

• This case highlights the possibility of primary bladder pheochromocytoma co-existing with or secondary to adrenal pheochromocytoma.
• It underscores the importance of thorough biochemical and imaging evaluation for persistent symptoms post-tumor resection.
• Early and accurate diagnosis of both primary and secondary pheochromocytomas is crucial for successful patient management.