Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Institute of Urology, Wuhan, China; Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Institute of Urology, Wuhan, China.
Urol Oncol. 2019 Jun;37(6):354.e9-354.e17. doi: 10.1016/j.urolonc.2019.01.027. Epub 2019 Feb 22.
Paragangliomas of the urinary bladder (PUBs) are challenging catecholamine-producing neuroendocrine tumors. We aimed to facilitate their diagnosis and treatment by functional and anatomical classifications.
Between April 2007 and September 2017, 31 cases from 2 centers were retrieved, in which the patients were pathologically diagnosed with PUB. Besides classifying them into functional and nonfunctional PUBs, functional PUBs were further subclassified into typical functional PUB (with typical symptoms and elevated catecholamines/metabolites levels) and atypical functional PUB. Anatomically, they were classified into submucosal, intramural, and subserosal PUBs.
Functionally, these cases comprised 17 (54.8%) functional and 14 (45.2%) nonfunctional PUBs. Functional PUBs had significantly larger diameters than nonfunctional PUBs (P < 0.01). Of the 17 functional PUB cases, 8 were further subclassified into typical functional PUB, of which 4 were diagnosed without cystoscopy. Anatomically, these cases comprised 14 (45.2%) submucosal, 13 (41.9%) intramural, and 4 (12.9%) subserosal PUBs. Intramural and subserosal PUBs had significantly larger diameters and were more likely to be functional than submucosal PUBs (P < 0.05). Cystoscopy failed to detect the tumor in all patients with subserosal PUB. Besides all patients with intramural or subserosal PUB, 1 patient with submucosal PUB underwent partial cystectomy. The remaining 13 patients with submucosal PUB underwent transurethral resection of bladder tumor, 5 of whom required extra surgical intervention.
By functional classification, omitting cystoscopy is feasible in the diagnosis of typical functional PUBs. By anatomical classification, intramural, and subserosal PUBs tend to be large and functional. Moreover, negative cystoscopic findings are not sufficient to exclude subserosal PUBs. Finally, not all submucosal PUBs are amenable to transurethral resection of bladder tumor.
膀胱副神经节瘤（PUB）是一种具有挑战性的儿茶酚胺分泌性神经内分泌肿瘤。我们旨在通过功能和解剖分类来促进其诊断和治疗。
在 2007 年 4 月至 2017 年 9 月期间，从 2 个中心共检索到 31 例患者，这些患者的病理诊断为 PUB。除了将其分为功能性和非功能性 PUB 之外，功能性 PUB 还进一步分为典型功能性 PUB（有典型症状和升高的儿茶酚胺/代谢物水平）和非典型功能性 PUB。解剖学上，它们被分为黏膜下、壁内和浆膜下 PUB。
在功能上，这些病例包括 17 例（54.8%）功能性和 14 例（45.2%）非功能性 PUB。功能性 PUB 的直径明显大于非功能性 PUB（P < 0.01）。在 17 例功能性 PUB 中，有 8 例进一步分为典型功能性 PUB，其中 4 例未经膀胱镜检查诊断。解剖学上，这些病例包括 14 例（45.2%）黏膜下、13 例（41.9%）壁内和 4 例（12.9%）浆膜下 PUB。壁内和浆膜下 PUB 的直径明显较大，并且比黏膜下 PUB 更可能具有功能性（P < 0.05）。在所有浆膜下 PUB 患者中，膀胱镜检查均未发现肿瘤。除了所有壁内或浆膜下 PUB 患者外，1 例黏膜下 PUB 患者接受了部分膀胱切除术。其余 13 例黏膜下 PUB 患者接受了经尿道膀胱肿瘤切除术，其中 5 例需要额外的手术干预。
通过功能分类，在诊断典型功能性 PUB 时可以省略膀胱镜检查。通过解剖分类，壁内和浆膜下 PUB 往往较大且具有功能性。此外，阴性膀胱镜检查结果不足以排除浆膜下 PUB。最后，并非所有黏膜下 PUB 都适合经尿道膀胱肿瘤切除术。
