Unrecognised adrenergic symptoms and the delayed diagnosis of urinary bladder paraganglioma

Tamara Dragović; Dejan Marinković; Snežana Kuzmić-Janković; Novak Milović; Božidar Kovačević; Zoran Hajduković

doi:10.2298/5773

Tamara Dragović Clinic for Endocrinology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Dejan Marinković Clinic for Endocrinology, Military Medical Academy, Belgrade, Serbia
Snežana Kuzmić-Janković Clinic for Endocrinology, Military Medical Academy, Belgrade, Serbia
Novak Milović Clinic for Urology, Military Medical Academy, Belgrade, Serbia Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Božidar Kovačević Institute of Pathology, Military Medical Academy, Belgrade, Serbia
Zoran Hajduković Clinic for Endocrinology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia

DOI: https://doi.org/10.2298/5773

Keywords: urinary bladder neoplasms, paraganglioma, diagnosis, urologic surgical procedures, histological techniques,

Abstract

Introduction. Paraganglioma is a rare neuroendocrine neoplasm that may arise from the extra-adrenal autonomic paraganglia. Urinary bladder paraganglioma is typically presented as repeated episodes of palpitations, headache or blood pressure rise immediately after micturition. Management of these tumors includes radical surgical treatment with preoperative antihypertensive preparation, and a life-long follow-up. Case report. We presented a middle-age female patient with functional urinary bladder paraganglioma, with a 3-year history of repeated episodes of abdominal pain, dysuria and hematuria. After obtaining more precise anamnestic data, the patient reported occasional simultaneous presence of mild adrenergic symptoms, that did not cause any particular attention at first. Morphological and biohumoral examinations suggested paraganglioma of the urinary bladder. Open partial cystectomy was performed, detecting a submucosal mass, while immunohistochemical analysis confirmed the presence of chromaffin tissue. Clinical manifestations, diagnostic approach, management and histopathological findings of urinary bladder paraganglioma are discussed. Conclusion. Since the prognosis with localized paraganglioma is good, we underlined the importance of a well-timed, accurate and detailed medical history in all the patients with even mild, inexplicable micturition-provoked adrenergic symptomatology.

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