Bladder Preservation for Patients With Bladder Paragangliomas: Case Series and Review of the Literature

Wang, Elizabeth; Pak, Jamie S.; Virk, Renu K.; Anderson, Christopher B.; Healy, Kelly A.; Lee, James A.; Benson, Mitchell C.; McKiernan, James M.

doi:10.1016/j.urology.2020.04.098

Cited by 5 publications

(12 citation statements)

References 40 publications

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“…To our best knowledge, this is the first case of its kind to be incidentally detected on transvaginal ultrasound during infertility workup and managed by cystoscopy-assisted LPC [7,8]. Unlike most common bladder tumors, PGLs are highly vascular neoplasm [3]. Consequently, imaging studies may play an important role in maintaining a high index of suspicion, even in nonfunctional and/or asymptomatic cases.…”

Section: Discussionmentioning

confidence: 84%

“…On MRI, which also provides knowledge on bladder wall infiltration, these tumors exhibit high-signal intensity on T2-weighted (T2W) images [2,6]. Some PGLs exhibit uptake of radioactive isotopes; therefore, nuclear imaging such as MIBG and positron emission tomography (PET) scans may be useful as functional tools in localizing the tumor [2][3][4]6]. As these tracers have physiological accumulation in the urinary bladder, the use of an MIBG scan was then helpful in primarily ruling out multifocal and/or metastatic disease in this case.…”

Section: Discussionmentioning

confidence: 99%

“…The endoscopic appearance of bladder PGLs is helpful when endocrine testing or imaging is inconclusive or when TUR of bladder tumor (TURBT) was done incidentally. On cystoscopy, PGL should be considered in the presence of yellowish submucosal mass, especially if the blood pressure shows fluctuations during the procedure [2][3][4]. However, performing a biopsy of bladder lesions suspicious for PGLs in the outpatient setting is not recommended given the risks of easy bleeding, false-negative results, and labile hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…They have uncertain malignant potential with unpredictable depth and behavior, demonstrating extravesical invasion in up to 50% of cases. How this entity can come about remains unclear, but it may have an inherited genetic susceptibility in up to 50% of cases [3]. It occurs in all age groups but more often in patients aged 20-40 years with no sex predominance [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…It occurs in all age groups but more often in patients aged 20-40 years with no sex predominance [1,2]. Most cases present with a well-defined set of symptoms related to excessive catecholamine release during bladder overdistension and/or micturition, including hypertensive crises, headache, palpitations, sweating, hot flushes that may be accompanied by painless hematuria, post micturition hypotension, or syncope [1][2][3]. A high index of clinical suspicion should lead to a measurement of 24-hour urine and/or plasma fractionated catecholamines and metanephrines.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Functional Bladder Paraganglioma as an Incidental Finding During Infertility Workup

Hajji¹,

Benazzouz²,

Hammoune³

et al. 2021

Cureus

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Bladder paragangliomas (PGLs) are extremely rare catecholamine-producing neuroendocrine tumors. They arise more frequently in the trigone and have unpredictable depth and behavior. Most cases typically present with a well-defined set of symptoms triggered by micturition or bladder overdistension. Besides long-term follow-up, they are usually managed by either transurethral resection (TUR) or partial cystectomy (PC). However, about 25% of all documented cases do not manifest clinically, raising both diagnosis and management challenges. This report describes an unusual case of a misdiagnosed, functional PGL arising on the bladder dome, which was fortuitously detected in a 21-year-old female during a fertility workup. Owing to its hypervascular nature and submucosal location, bladder PGL was suspected on ultrasound and CT findings and successfully diagnosed before surgery through biochemical confirmation. It was managed by cystoscopy-guided laparoscopic partial cystectomy (LPC) with good oncological and urinary outcomes, as well as no compromise of her fertility potential. To our best knowledge, this is the first case to be incidentally detected on transvaginal ultrasound during evaluation for infertility. This case also stresses the importance of considering PGL in the differential diagnosis of atypical bladder tumors, as well as conservative management through simultaneous laparoscopy and cystoscopy, when approaching young patients with large functional PGL.

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Section: Discussionmentioning

confidence: 84%