Incidentally Detected Urinary Bladder Paraganglioma

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A 65-year-old woman was referred for a urinary bladder mass incidentally detected on preoperative computed tomography (CT) for breast cancer (A). She had hypertension for >10 years and experienced palpitations following urination every few months but had no other urinary or catecholamine excess symptoms.

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Magnetic resonance imaging showed the tumor within the bladder muscularis, displaying partly high signal intensity on T1- and T2-weighted images, raising the possibility of urinary bladder paraganglioma (UBPGL) (B, T2-weighted image) [1]. A 24-hour urinalysis revealed elevated levels of norepinephrine and normetanephrine. Increased tracer uptake in the bladder mass on ¹²³I-meta-iodobenzylguanidine (MIBG) scintigraphy (C) supported the UBPGL diagnosis. No other pathologic uptake was observed on the ¹²³I-MIBG scintigraphy. Additionally, ¹⁸F-fluorodeoxyglucose positron emission tomography-CT showed increased accumulation in the urinary bladder mass (D). The patient underwent open partial cystectomy without major complications under doxazosin treatment. Histopathology confirmed the diagnosis of UBPGL. Postoperatively, plasma norepinephrine and urinary normetanephrine levels returned to normal.

Only 6% of UBPGLs are incidentally discovered and accurately diagnosed before biopsy or surgery [2]. Accurate diagnosis and appropriate management of UBPGL are crucial to prevent life-threatening perioperative complications [2]. The integration of multiple imaging modalities and hormonal evaluation provides essential information for diagnosing UBPGL.

Acknowledgments

We thank the medical staff at the NHO Kyoto Medical Center for their support. We would like to thank Enago (www.enago.com) for English language editing.

Funding

This work was partially supported by a grant from the Takeda Science Foundation (to K.N.).

Disclosures

K.N. is an editorial board member of JCEM Case Reports and played no role in the Journal's evaluation of the manuscript. K.N. received a research grant from AstraZeneca, which is unrelated to the content of this work. The other authors have nothing to disclose.

Informed Patient Consent for Publication

Signed informed consent obtained directly from patient.

Data Availability Statement

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

References

Abbreviations

 
• CT

  computed tomography

 
• MIBG

  meta-iodobenzylguanidine

 
• UBPGL

  urinary bladder paraganglioma