Paraganglioma Case Study

Pheochromocytomas are rare tumors arising exclusively from the chromaffin tissue of the sympathetic nervous system in adrenal medulla, However, the similar tumors that arise from same tissue in other locations are referred to as paragangliomas according to the most recent classification done by World Health Organization classification of tumours.1,2 Only 1% of paragangliomas are found in the urinary bladder which account for less than 0.06% of all bladder malignancies.3,4 Paraganglioma of the urinary bladder is originates from Sympathetic plexus which is scattered among all the layers of the urinary bladder wall and most of it are intramural in location and present as submucosal tumors.5.
Paraganglioma of the urinary bladder may be functional and symptomatic in more than half of the cases, or non-functional tumour as our report case.6 Symptomatic paraganglioma of the bladder may be present with the symptoms of hypertension, headache, palpitations, and hematuria and even up to Micturition syncope. These symptoms are caused by compression and therefore irritation of the tumor in the bladder wall which result in increased catecholamine release during detrusor contraction during micturition, bladder …show more content…
The presence of large polygonal cells with abundant granular cytoplasm arranged in a Zellballen pattern nests surrounded by a fibrous network rich in blood vessels is pathognomonic to paragangliomas. These findings are confirmed by immunohistochemical analysis for neuroendocrine markers, such as positive for chromogranin and synaptophysin but negative for urothelial marker cytokeratin.14 On review of literature, about 5 to-15% of the paragangliomas of the urinary bladder are malignant. Evidence of local invasion or distant metastases is the only help to distinguish between benign and malignant