Aryal Sajiva, Sharma Suraj, Shrestha Sumira, Parajuli Sabina, Duwadee Prabin, Bista Pratibha
Department of Pathology, National Academy of Medical Sciences, Bir Hospital, Mahaboudha, Nepal.
Department of Medicine, Chitwan Medical College, Bharatpur, Nepal.
Ann Med Surg (Lond). 2025 May 26;87(7):4651-4654. doi: 10.1097/MS9.0000000000003429. eCollection 2025 Jul.
Bladder paraganglioma is a rare neuroendocrine tumor, accounting for less than 0.06% of all bladder tumors. Due to its nonspecific symptoms, it is frequently misdiagnosed, leading to delays in appropriate management.
We report a case of a 45-year-old female who presented with post-micturition palpitations, diaphoresis, hypertensive episodes, and chronic lacunar infarcts for several years. Initially misdiagnosed with an anxiety disorder and later migraine with generalized anxiety disorder, her symptoms persisted despite psychiatric and neurological treatments. Further evaluation with ultrasonography and CT-intravenous urography revealed a bladder mass, prompting surgical intervention. Histopathology confirmed bladder paraganglioma with classic Zellballen architecture, and immunohistochemistry showed positivity for chromogranin A, synaptophysin, and CD56.
Bladder paragangliomas are frequently mistaken for other bladder neoplasms or functional disorders due to their variable presentation. Imaging plays a crucial role in diagnosis, but definitive confirmation relies on histopathology and immunohistochemistry. Surgical excision remains the gold standard for treatment, with long-term follow-up necessary due to the potential for recurrence.
This case highlights the diagnostic challenges of bladder paraganglioma, emphasizing the need for a high index of suspicion in patients presenting with unexplained hypertensive crises or post-micturition symptoms. Early recognition and appropriate management are essential for optimal patient outcomes.
膀胱副神经节瘤是一种罕见的神经内分泌肿瘤，占所有膀胱肿瘤的比例不到0.06%。由于其症状不具特异性，常被误诊，导致延误适当治疗。
我们报告一例45岁女性，她出现排尿后心悸、多汗、高血压发作以及数年的慢性腔隙性梗死。最初被误诊为焦虑症，后来又被诊断为伴有广泛性焦虑症的偏头痛，尽管接受了精神科和神经科治疗，她的症状仍持续存在。超声检查和CT静脉肾盂造影进一步评估发现膀胱肿块，促使进行手术干预。组织病理学证实为具有典型Zellballen结构的膀胱副神经节瘤，免疫组化显示嗜铬粒蛋白A、突触素和CD56呈阳性。
膀胱副神经节瘤因其表现多样，常被误诊为其他膀胱肿瘤或功能性疾病。影像学在诊断中起关键作用，但确诊依赖于组织病理学和免疫组化。手术切除仍是治疗的金标准，由于有复发的可能，需要长期随访。
本病例突出了膀胱副神经节瘤的诊断挑战，强调对出现不明原因高血压危象或排尿后症状的患者要有高度的怀疑指数。早期识别和适当治疗对患者获得最佳预后至关重要。
