Hypertension secondary to a periprostatic paraganglioma: case report and review of the literature

Abstract

BackgroundAround 10 per cent of catecholamine-secreting tumours can be found outside the adrenal medulla (paraganglioma). We report a case of a functional sporadic paraganglioma that was localized lateral to the prostate without causing lower urinary tract symptoms.Case presentationA 76-year old male with an extensive history of cardiovascular disease suffered from hypertension and an unexplained hypochromic microcytic anaemia for years before the coincidental discovery of a 2.5 × 3.5 cm periprostatic mass upon abdominal contrast-enhanced CT scanning. Transrectal biopsies revealed a paraganglioma. The urinary levels of the catecholamine metabolites were found increased. The paraganglioma showed uptake of iodine-123-metaiodobenzylguanidine by SPECT scanning, indicating a solitary lesion. Successful preperitoneal endoscopic resection of the tumour was performed, which resulted in a decrease in blood pressure and a normalization of the urinary catecholamine metabolites. None of the to date known genetic mutations that have been shown to relate to the existence of paragangliomas were identified in the current case.ConclusionAn intra- or periprostatic localization of a paraganglioma is very rare. We reviewed the literature and found 6 other cases. Three of the described cases presented with lower urinary tract symptoms. In these three patients, the tumour had a size of 4 cm or larger and in 67 per cent of these cases the paragangliomas were situated within the prostate. The periprostatic region might be considered as a possible location for paragangliomas, especially in the presence of lower urinary tract symptoms even though they were absent in the current case.

Targeting the vessels first: A modified surgical technique for prostatic paraganglioma

“…Surgical treatment reported includes radical transurethral resection, enbloc resection of tumor or radical prostatectomy 2,3 . These surgical treatments are usually carried out under adrenergic blockade and volume expansion, in a similar manner as adrenal pheochromocytomas.…”

Urology pertinent neuroendocrine tumors: focusing on renal pelvis, bladder, prostate located sympathetic functional paragangliomas

“…As regards the prostate or periprostatic sympathetic paragangliomas, the symptomatology, in addition to that generally prostatism-related, consists in catecholamine hypersecretion-due typical expressions such as heart aberrant palpitations, palaness, headache and sweating attacks besides mic- turition-triggered possible cardiac arrhythmia and syncope, sometimes occurring also after defecation and digital rectal examination (17)(18)(19)(20)(21)(22).…”

“…External beam radiation-or radionuclide ¹³¹I-MIBG-or even ²²³Ra-therapy may be carried-out particularly for palliative treatment of painful symptoms of malignant paraganglioma-related bone metastatic lesions (10,17,18,22).…”

“…As regards a possible identified periprostatic -prostate closely located -sympathetic paraganglioma, the surgical treatment is usually confined to open/laparoscopic only tumor excision, still with previous both adrenergic blockade and plasma volume expansion (17,18,21).…”