Radiotherapy for urinary bladder pheochromocytoma with invasion of the prostate: A case report and literature review

Abstract

Malignant pheochromocytoma is a rare tumor, for which there is currently no effective therapy. Cytoreductive surgery is recommended to reduce tumor burden and relieve the symptoms of catecholamine excess, although complete eradication of the lesions is often not feasible. In patients with advanced disease, for whom surgical resection is not an option, systemic chemotherapy, radiotherapy and treatment with iodine-131-meta-iodobenzylguanidine may be used to achieve symptomatic relief. Although malignant pheochromocytoma is considered to be unresponsive to radiotherapy, a limited number of case reports, although not large patient samples, have been published on the effectiveness of radiotherapy for the treatment of this disease. This is the case report of a 23-year-old male patient with bladder pheochromocytoma invading the prostate, who refused to undergo surgery. The tumor shrank following radiotherapy and had not increased in size 1.5 years after treatment. Similarly, the blood pressure of the patient remained within normal limits without antihypertensive medication; the levels of catecholamines and their metabolites also remained normal. Our case demonstrated that radiotherapy was effective for malignant pheochromocytoma to a certain extent and, therefore, it may be selected when surgery is not feasible.

Keywords: bladder; paraganglioma; pheochromocytoma; radiotherapy.

Figure 1.

Magnetic resonance imaging (MRI) prior to radiotherapy. Enhanced MRI showing a lesion sized 60×44×63 mm in the prostate and bottom of the bladder, with an unclear boundary. The lesions exhibited marked inhomogeneous enhancement and the bladder wall thickening was not uniform.

Figure 2.

Magnetic resonance imaging (MRI) following radiotherapy. An enhanced MRI revealed that the size of the lesion in the prostate and bladder had decreased to 30×25×29 mm following radiotherapy. The boundary of the lesion was still unclear and the lesion exhibited inhomogeneous enhancement.