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12 May 2015 : Case report  USA

Urinary Bladder Paraganglioma presenting as Micturition-Induced Palpitations, Dyspnea, and Angina

Challenging differential diagnosis, Unusual setting of medical care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Arindam BagchiABDEF, Kola DushajEF, Anup ShresthaDEF, Anatoly L. LeytinDE, Shamsul A. BhuiyanCE, Farshid RadparvarCE, Shlomo TopchikCD, Sandeep Singh TuliBDE, Paul KimDE, Sanjiv BakshiABDEF

DOI: 10.12659/AJCR.891388

Am J Case Rep 2015; 16:283-286

Abstract

BACKGROUND: Sympathetic urinary bladder paragangliomas are rare catecholamine-secreting neuroendocrine tumors arising from neural crest cells. They are uncommon urinary bladder neoplasms. Symptoms classically include micturition-related or unrelated palpitations and syncope with hypertension, headaches, diaphoresis, and hematuria. Other than being attributable to vasovagal reactions, micturition-induced cardiovascular symptoms should prompt a search for catecholamine-secreting tumors such as a urinary bladder paraganglioma, as in this case.

CASE REPORT: A 45-year-old asthmatic African-American female presented with episodic hematuria that began 4 years ago and episodes of micturition-induced palpitations, dyspnea, substernal tightness, sweating, and throbbing headaches. Computed tomography with contrast revealed an enhancing mass along the anterior urinary bladder wall, measuring 2.4×3.5 cm. On Positron emission Tomography with [18F] fluorodeoxyglucose integrated with computed tomography (18F-FDG PET/CT), the urinary bladder mass was 18F-FDG avid. Serum normetanephrine and supine plasma norepinephrine were significantly elevated and there was mild elevation of supine plasma epinephrine. Transurethral resection of the bladder mass revealed a neoplasm with microscopic features and immunohistochemical profile positive for synaptophysin and chromogranin, with negative screening cytokeratin AE1/AE3, suggesting a paraganglioma. Following resection of the paraganglioma, there was complete resolution of micturition-induced cardiovascular symptoms on long-term follow-up.

CONCLUSIONS: Micturition-related cardiovascular symptoms are commonly attributed to vasovagal reactions. However, urinary bladder pathologies must be ruled out as a cause, as in this rare case of a urinary bladder paraganglioma exhibiting catecholaminergic symptoms.

Keywords: Diagnosis, Differential, Angina Pectoris - etiology, Dyspnea - etiology, Paraganglioma - diagnosis, Positron-Emission Tomography, Tomography, X-Ray Computed, Urinary Bladder Neoplasms - diagnosis, Urination

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923