Challenging differential diagnosis, Unusual setting of medical care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Arindam Bagchi, Kola Dushaj, Anup Shrestha, Anatoly L. Leytin, Shamsul A. Bhuiyan, Farshid Radparvar, Shlomo Topchik, Sandeep Singh Tuli, Paul Kim, Sanjiv Bakshi
(Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA)
Am J Case Rep 2015; 16:283-286
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, Female, Humans, Middle Aged, Paraganglioma - diagnosis, Positron-Emission Tomography, Tomography, X-Ray Computed, Urinary Bladder Neoplasms - diagnosis, Urination