Malignant paraganglioma of the urinary bladder

Paragangliomas of the urinary bladder is one of the rare tumors and accounts for 0.06% of all bladder tumors. Malignancy is uncommon, occuring in 10-15% of the bladder paragangliomas with less than 20 cases previously reported and determined by its clinical behaviour rather than the histological features. Herein, we describe a case of urinary bladder paraganglioma in a 33-year-old male patient who exhibited with macroscopic painless hematuria. On ultrasonographic examination, a 6 cm × 4 cm mass along the left lateral wall of the urinary bladder was detected. The patient underwent CT examination, which revealed a hyperdense mass with some calcification in it. Also bilateral obturator and iliac lymph nodes measuring up to 2 cm were detected. MR imaging was also performed and again an intense enhancing mass in the left lateral wall of the bladder with bilateral lymph nodes and possible invasion to the seminal vesicles and sigmoid colon was shown. In the laboratory analysis, the 24 h urine vanillylmandelic acid (VMA) level was significantly elevated. During transurethral cystoscopy (TUR) and biopsy a hypertension crisis occured which was controlled by medical therapy. Following histopathologic analysis the diagnosis was established as paraganglioma. The patient has undergone radiation therapy for 2 months and only minimal regression of the tumoral size was observed. Due to the fact that long term follow-up is mandatory for these tumors, the patient is closely being monitored by the urology clinic.