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Lessons to be learned: a case study approach Paraganglioma of the urinary bladder

Asir Central Hospital, Abha, Saudi Arabia

Mohammad Rasshid, MB, BS

Department of Urology, Asir Central Hospital, Abha, Saudi Arabia

Elfadil Ma Elmalik, FRCS

Asir Central Hospital, Abha, Saudi Arabia

Mohammad Amin Ansari, MD

Laboratory Medicine, Asir Central Hospital, Abha, Saudi Arabia

Nader Morad, FCAP

Asir Central Hospital, Abha, Saudi Arabia

Primary paraganglioma arises in frequently in the uri nary bladder. We present here the clinicopathologi cal, immunohistochemical and ultrastructural find ings in a 23-year-old Saudi female. She was hospi talised because of gross haematuria over the previ ous seven days. The intravenous urogram revealed a filling defect in the urinary bladder. Cystoscopy dis closed a non-papillary tumour arising from the roof of the bladder neck. Transurethral resection was, accordingly, performed - but marked fluctuation in blood pressure was observed during the procedure. The histopathological findings of trabeculae and small nests of plump oval to spindle cells with a clear to acidophilic cytoplasm, forming an organoid pat tern and demonstrating inconspicuous mitotic activ ity, were diagnostic of paraganglioma of the urinary bladder; the diagnosis was confirmed by means of immunohistochemical and ultrastructural studies. The endocrine markers chromogranin A and neu ron-specific enolase were positive in chief cells; sus tentacular cells at the periphery of neoplastic cell clusters were positive for S-100 protein. Neurosecre tory granules were identified by electron microscop ic examination. It is emphasised that, currently, there are no anatomico-pathological criteria to distinguish benign and malignant forms of the disease. Post-sur gical recovery was uneventful in this case. Recurrence and metastases, though infrequent, have been report ed in the literature; therefore, radiation therapy may be an important adjunct - and long-term follow-up is mandatory.

Key Words: Extraadrenal phaeochromocytoma • neuroendocrine system • paraganglioma • tumour markers • urinary bladder

The Journal of the Royal Society for the Promotion of Health, Vol. 121, No. 3, 193-198 (2001)
DOI: 10.1177/146642400112100317


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