An Unusual Presentation of Paraganglioma of the Bladder Presenting With Hypertensive Crisis During Micturition

ABSTRACT Objective: Pheochromocytomas most commonly occur in the adrenal glands and affect most patients with characteristic symptoms of headache, palpitations, and sweats. They can occur in extra-adrenal organs such as the bladder and cause symptoms related to the location, such as micturition and hematuria. We report the case of a 56-year-old female with paraganglioma of the bladder. Methods: The patient had initial symptoms that were suspicious for pheochromocytoma. Imaging done with computed tomography of the adrenals was negative and 123I-meta-iodobenzylguanidine scanning of the whole body done with bladder shielding were not interpreted initially as suspicious for bladder paraganglioma. A bladder ultrasound and computed tomography of the lower urinary tracts confirmed the lesion. The patient underwent partial cystectomy, and examination of the surgical specimen revealed a paraganglioma of the bladder. Results: A review of the literature was conducted to identify previous studies pertaining to bladder paraganglioma, focusing on reports related to their management. Conclusion: Paraganglioma of the bladder, although rare, should be strongly considered in patients with pertinent symptoms related to the location of the tumor, such as micturition and hypertensive episodes during urination. Initial inattention to the patient's manifestations may lead to a delay in the diagnosis. Clinical suspicion after carefully listening to the patient should lead to the subsequent evaluation and localization of the tumor. Abbreviations: CT = computed tomography MIBG = 123I-meta-iodobenzylguanidine MRI = magnetic resonance imaging SDH = succinate dehydrogenase