Pneumovesicoscopic en bloc resection of multifocal bladder paraganglioma: a case report
- 1Department of Urology, First People's Hospital of Kunshan, Kunshan, China
Abstract
Background: Bladder paraganglioma is a rare non-epithelial neuroendocrine tumor. Catecholamine release may cause micturition-related headache, palpitations, sweating, paroxysmal hypertension, or syncope, but cases without typical symptoms can be difficult to recognize before surgery. Complete surgical excision remains the mainstay of treatment.
Case presentation: A 75-year-old woman was admitted after two bladder lesions were detected. She had no hematuria, lower urinary tract symptoms, or micturition-related headache, palpitations, sweating, or paroxysmal hypertension. Contrast-enhanced CT showed two hypervascular nodules near the bladder neck and on the left posterior wall, measuring 12 × 14 mm and 6 × 9 mm, respectively. Twenty-four-hour urinary free catecholamines were within the reference ranges. Plasma free normetanephrine was mildly elevated at 0.96 nmol/L (upper reference limit, 0.71 nmol/L; approximately 1.35 × ULN) when measured by LC-MS/MS under standardized sampling conditions, whereas plasma metanephrine and 3-methoxytyramine remained within their reference ranges. This profile was considered consistent with a clinically silent but mildly biochemically functional tumor. The patient underwent pneumovesicoscopic en bloc resection. Histopathology confirmed multifocal bladder paraganglioma confined to the submucosa, with negative surgical margins, a Ki-67 proliferation index <1%, and retained SDHB expression. Recovery was uneventful, and cystoscopy showed no recurrence at 12 months.
Conclusions: Bladder paraganglioma should be considered in a hypervascular submucosal bladder mass with intact overlying mucosa even when typical catecholamine-related symptoms are absent. This single case supports the technical feasibility of pneumovesicoscopic en bloc resection for selected localized lesions, but the 12-month follow-up is insufficient to establish comparative effectiveness or long-term oncologic safety.
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BibTeX
@article{wang2026pneumovesicoscopic,
title = {{Pneumovesicoscopic en bloc resection of multifocal bladder paraganglioma: a case report}},
author = {Bing Wang and Yu Hong and Tianhai Liao and Dingli Hu and Yunlong Li},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1992514},
url = {https://doi.org/10.3389/fmed.2026.1992514},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Pneumovesicoscopic en bloc resection of multifocal bladder paraganglioma: a case report
AU - Bing Wang
AU - Yu Hong
AU - Tianhai Liao
AU - Dingli Hu
AU - Yunlong Li
PY - 2026
DA - 2026/10/21
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1992514
UR - https://doi.org/10.3389/fmed.2026.1992514
AB - Background: Bladder paraganglioma is a rare non-epithelial neuroendocrine tumor. Catecholamine release may cause micturition-related headache, palpitations, sweating, paroxysmal hypertension, or syncope, but cases without typical symptoms can be difficult to recognize before surgery. Complete surgical excision remains the mainstay of treatment. Case presentation: A 75-year-old woman was admitted after two bladder lesions were detected. She had no hematuria, lower urinary tract symptoms, or micturition-related headache, palpitations, sweating, or paroxysmal hypertension. Contrast-enhanced CT showed two hypervascular nodules near the bladder neck and on the left posterior wall, measuring 12 × 14 mm and 6 × 9 mm, respectively. Twenty-four-hour urinary free catecholamines were within the reference ranges. Plasma free normetanephrine was mildly elevated at 0.96 nmol/L (upper reference limit, 0.71 nmol/L; approximately 1.35 × ULN) when measured by LC-MS/MS under standardized sampling conditions, whereas plasma metanephrine and 3-methoxytyramine remained within their reference ranges. This profile was considered consistent with a clinically silent but mildly biochemically functional tumor. The patient underwent pneumovesicoscopic en bloc resection. Histopathology confirmed multifocal bladder paraganglioma confined to the submucosa, with negative surgical margins, a Ki-67 proliferation index <1%, and retained SDHB expression. Recovery was uneventful, and cystoscopy showed no recurrence at 12 months. Conclusions: Bladder paraganglioma should be considered in a hypervascular submucosal bladder mass with intact overlying mucosa even when typical catecholamine-related symptoms are absent. This single case supports the technical feasibility of pneumovesicoscopic en bloc resection for selected localized lesions, but the 12-month follow-up is insufficient to establish comparative effectiveness or long-term oncologic safety.
SN - 2296-858X
ER -