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Non-functional muscle-invasive bladder paraganglioma-a case report
Joshua S Jue1,2, Jonathan Weinreich1,2, Noel A Armenakas1,2
1Department of Urology, Lenox Hill Hospital, Northwell Health, New York, NY, USA.
AME Case Reports
|October 9, 2024
Summary
Extra-adrenal pheochromocytoma (paraganglioma) of the urinary bladder is rare but can be aggressive. Early recognition and surgical resection are key for managing this tumor and preventing complications like hypertensive crisis.
Area of Science:
- Urology
- Endocrinology
- Surgical Oncology
Background:
- Extra-adrenal pheochromocytoma, or paraganglioma, is a rare urinary bladder tumor (0.05% of bladder tumors).
- These tumors, most common in the genitourinary tract, possess aggressive malignant potential, necessitating complete surgical resection.
- Paragangliomas can be non-functional or functional, secreting catecholamines, and are challenging to differentiate from urothelial carcinoma.
Observation:
- A rare case of a non-functional paraganglioma in the bladder of a 46-year-old male is presented.
- The tumor's location near the bladder neck required specialized equipment for visualization.
- A golden-yellow sessile mass was observed during surgical resection.
Findings:
- Intraoperative manipulation of bladder paragangliomas can precipitate a catecholamine surge, leading to complications.
- Gross visualization of a golden-yellow sessile bladder mass should raise suspicion for paraganglioma.
- Biochemical evaluation of catecholamines, metanephrines, and normetanephrines is crucial for assessing tumor functionality.
Implications:
- Preoperative or early intraoperative recognition of bladder paraganglioma is vital for implementing appropriate alpha blockade.
- Hemodynamic optimization and surgical management are essential for suspected localized bladder paraganglioma.
- Prompt recognition facilitates minimizing patient morbidity and preventing intraoperative hypertensive crises.
