A rare case of non-functional Paraganglioma of urinary bladder with No LUTS

Abstract

Paraganglioma originates from chromaffin cells of the sympathetic nervous system. Paraganglioma of urinary bladder are very rare tumors that arise from the ganglion cells and usually mistakenly have been diagnosed and treated because of its rarity and diverse symptoms. Here, we present our patient with incidental finding of non-functional paraganglioma of urinary bladder who showed no lower urinary tract symptoms (LUTS). Timely diagnosis, treatment, and postoperative reviews are in effect for management of these patients.

1 Introduction

Paragangliomas are catecholamine-producing neoplasms arising from chromaffin cells of the sympathetic nervous system that are frequently diagnosed in an intradiaphragmatic position. Paraganglioma of bladder was described for the first time by Zimmerman et al., in 1953 as pheochromocytoma of the urinary bladder in an old woman. The tumor originates from the ganglion cells in the bladder wall, frequently on the trigone, with an average tumor size of 3.9 cm. Paraganglioma of urinary bladder is an infrequent tumor that represents only 0.06 percent of all urinary tumors and less than one-tenth of paragangliomas are found in the urinary bladder. ^,

According to their scarcity and the varying symptoms, paraganglioma of urinary bladder is usually mistakenly diagnosed and treated. Here, we present our patient with a non-functional paraganglioma of urinary bladder.

2 Case presentation

Here, we are presenting our patient who was a 72-year-old woman with an incidental finding of a heterogeneous mass on the floor of urinary bladder in an MRI study that was done for her hip joint problem. She had a history of lower limb pain and hypertension which was under control by regular use of Losartan. For precise study pelvic and abdomen MRI without and with IV gadolinium was carried out. Results showed 40∗28 lobulated intermediate signal intensity mass in T2w and low signal in T1w from the anterior wall of the urinary bladder with extension to the proximal part of the urethra. No sign of lymphadenopathy in the pelvic cavity or inguinal region was detected. After gadolinium injection, a marked enhancement without invasion out of the bladder was observed ( Fig. 1 ). Chest CT scan showed no mass.

Transurethral resection of bladder tumor (TURBT) was done and microscopic evaluation of the specimen showed cells with pleomorphic and large granular nuclei and nucleoli without prominent mitotic figures and large eosinophilic granular cytoplasms in the vascular stroma. Some mucin-producing glands within the tumor were identified. In IHC test, Synaptophysin, chromogranin, vimentin and GATA3 were positive and CK (AE1/AE3), CK7, CK20, CAM5.2, EMA, S100 protein and CD68 were reported negative. Ki67 stain showed a very low proliferative index. Pathology determined Paraganglioma in the background of cystitis glandularis. Laboratory studies showed a normal range of urine and plasma catecholamines.

Bladder mass was resected through partial cystectomy ( Figs. 2 and 3 ) and the after 2 days the patient was discharged in good condition. Six months later she was visited with no medical problem and advised to follow regularly.