Paraganglioma of the urinary bladder first presented by bladder bloody tamponade: two case reports and review of the literatures

Abstract

Pheochromocytomas and paragangliomas (extra-adrenal pheochromocytomas) are catecholamine-secreting tumors. The paraganglioma of the urinary bladder is an uncommon neoplasm with a higher malignancy rate. Only about 60% of bladder paragangliomas presented with hematuria, and most of them were microscopic hematuria. Herein, we report two cases of bladder paraganglioma with bladder bloody tamponade. In Case 1, radical cystectomy and regional lymphadenectomy were performed for a huge bladder tumor and left pelvic lymph nodes metastasized. In Case 2, we chose endoscopic transurethral resection of the bladder tumor. Literatures since 1989 were also reviewed to illustrate the clinical characteristics and current treatments.

Figure 1

Case 1: (A) a huge multi‐nodular soft tissue mass (9.1  ×  8.4 cm in diameter) arising from the base and posterior wall of the bladder; (B) the enhanced tumor with multiple neovasculaity and central necrosis. Case 2: (C) a contrast‐enhanced mass (3.27  ×  3 cm) in the urinary bladder arising from the dome area with bladder bloody tamponade; (D) the sagittal view shows the tumor with muscle‐level invasion.

Figure 2

(A) The macroscopic appearance of paraganglioma of the urinary bladder (Case 1) is shown. (B) The tumor cells, from bladder tumor and the lymph node metastasis, are round with acidophilic granular cytoplasm and ovoid nuclei with fine granular chromatin. They are arranged in discrete nests (the zellballen pattern) separated by a prominent vascular network (hematoxylin‐eosin, reduced from 400×). (C) Immunohistochemistry demonstrates positive staining for chromogranin. (D) Immunohistochemistry demonstrates negative staining for cytokeratin. It has been used for differentiating the diagnosis from transitional cell carcinoma. All specimens are from Case.