Urinary bladder paraganglioma presenting as micturition-Induced palpitations, dyspnea, and angina

Arindam Bagchi, Kola Dushaj, Anup Shrestha, Anatoly L. Leytin, Shamsul A. Bhuiyan, Farshid Radparvar, Shlomo Topchik, Sandeep Singh Tuli, Paul Kim, Sanjiv Bakshi

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objective: Rare disease 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.

Original languageEnglish
Pages (from-to)283-286
Number of pages4
JournalAmerican Journal of Case Reports
Volume16
DOIs
StatePublished - 12 May 2015

Keywords

  • Palpitations
  • Paraganglioma, extra-adrenal
  • Urinary bladder neoplasms

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