Calamaro Paola, Ravetti Jean Louis, Toncini Carlo
Anal Quant Cytopathol Histpathol. 2014 Oct;36(5):290-4.
Urinary bladder paraganglioma is a rare neoplasm that originates from embryonic rests of chromaffin cells in the sympathetic plexus of the detrusor muscle, and which occasionally can be observed in transurethral resection specimens. Artifactual changes due to the procedure may frequently simulate an advanced urothelial carcinoma.
A 65-year-old woman presented with episodic macroscopic hematuria. No symptoms of hyperadrenergic stimulation were referred. Cystoscopic examination revealed a protruding mass on the left side of the bladder. Transurethral resection (TUR) was performed, and histological examination revealed a tissue organized in solid nests delineated by delicate fibrovascular septa. There were artifactual changes that consisted of cautery effect and absence of orientation of the fragments. The tumor infiltrated the muscle layer and part of the muscularis mucosae of the bladder. No necrosis or mitoses were observed. On immunohistochemical staining, the tumor cells were negative for epithelial membrane antigen, cytokeratin 7, and carcinoembryonic antigen and positive for chromogranin A, NSE, and PGP9.5. Immunohistochemistry for S-100 highlighted sustentacular cells.
It is essential to consider the diagnosis of urinary bladder paraganglioma on TUR specimens in order to avoid inappropriate treatment.
膀胱副神经节瘤是一种罕见的肿瘤，起源于逼尿肌交感神经丛中嗜铬细胞的胚胎残余，偶尔可在经尿道切除标本中观察到。手术引起的人为改变常可模拟高级别尿路上皮癌。
一名65岁女性，表现为间歇性肉眼血尿。未提及高肾上腺素能刺激症状。膀胱镜检查发现膀胱左侧有一突出肿物。进行了经尿道切除术（TUR），组织学检查显示肿瘤组织呈实性巢状排列，由纤细的纤维血管间隔分隔。存在由烧灼效应和碎片无定向组成的人为改变。肿瘤浸润膀胱肌层和部分黏膜肌层。未观察到坏死或核分裂象。免疫组化染色显示，肿瘤细胞上皮膜抗原、细胞角蛋白7和癌胚抗原阴性，嗜铬粒蛋白A、神经元特异性烯醇化酶和PGP9.5阳性。S-100免疫组化突出显示了支持细胞。
为避免不恰当的治疗，在经尿道切除标本上考虑膀胱副神经节瘤的诊断至关重要。
