Hajji Fouad, Benazzouz Abderrazak, Hammoune Nabil, Azami Mohamed Amine, Ghoundale Omar
Department of Urology, Ibn Sina Military Hospital, Marrakech, MAR.
Department of Radiology, Ibn Sina Military Hospital, Marrakech, MAR.
Cureus. 2021 Oct 16;13(10):e18815. doi: 10.7759/cureus.18815. eCollection 2021 Oct.
Bladder paragangliomas (PGLs) are extremely rare catecholamine-producing neuroendocrine tumors. They arise more frequently in the trigone and have unpredictable depth and behavior. Most cases typically present with a well-defined set of symptoms triggered by micturition or bladder overdistension. Besides long-term follow-up, they are usually managed by either transurethral resection (TUR) or partial cystectomy (PC). However, about 25% of all documented cases do not manifest clinically, raising both diagnosis and management challenges. This report describes an unusual case of a misdiagnosed, functional PGL arising on the bladder dome, which was fortuitously detected in a 21-year-old female during a fertility workup. Owing to its hypervascular nature and submucosal location, bladder PGL was suspected on ultrasound and CT findings and successfully diagnosed before surgery through biochemical confirmation. It was managed by cystoscopy-guided laparoscopic partial cystectomy (LPC) with good oncological and urinary outcomes, as well as no compromise of her fertility potential. To our best knowledge, this is the first case to be incidentally detected on transvaginal ultrasound during evaluation for infertility. This case also stresses the importance of considering PGL in the differential diagnosis of atypical bladder tumors, as well as conservative management through simultaneous laparoscopy and cystoscopy, when approaching young patients with large functional PGL.
膀胱副神经节瘤（PGLs）是极其罕见的产生儿茶酚胺的神经内分泌肿瘤。它们更常发生于膀胱三角区，深度和行为难以预测。大多数病例通常表现为由排尿或膀胱过度扩张引发的一组明确症状。除了长期随访外，它们通常通过经尿道切除术（TUR）或部分膀胱切除术（PC）进行治疗。然而，在所有已记录的病例中，约25%没有临床症状，这给诊断和治疗带来了挑战。本报告描述了一例罕见的误诊功能性PGL病例，该肿瘤发生于膀胱顶部，在一名21岁女性进行生育检查时偶然被发现。由于其血管丰富的性质和黏膜下位置，根据超声和CT检查结果怀疑为膀胱PGL，并在手术前通过生化确认成功诊断。通过膀胱镜引导下的腹腔镜部分膀胱切除术（LPC）进行治疗，取得了良好的肿瘤学和泌尿学效果，且未影响其生育潜力。据我们所知，这是第一例在不孕症评估过程中经阴道超声偶然发现的病例。该病例还强调了在非典型膀胱肿瘤的鉴别诊断中考虑PGL的重要性，以及在处理患有大型功能性PGL的年轻患者时通过同时进行腹腔镜和膀胱镜检查进行保守治疗的重要性。
