Bladder Paraganglioma Presenting as Post-Micturition Palpitations: A Case Report.

Introduction: Paraganglioma of the urinary bladder (PUB) is an extremely rare extra-adrenal catecholamine-secreting neuroendocrine tumor, accounting for only 0.05% of all bladder tumors and 1% of all pheochromocytomas. The clinical presentation of PUB can be diverse and challenging to diagnose. Case Presentation: This case report presents a 37-year-old man with post-micturition palpitation, headache, and sweating, with no history of hematuria or other irritative urinary symptoms. Ultrasound and contrast-enhanced computed tomography revealed a suspicious mass in the right posterolateral wall of the urinary bladder. Despite normal functional hormonal tests, the diagnosis of PUB was confirmed after surgical enucleation and histopathological examination. Conclusion: This report emphasizes the importance of considering PUB as a differential diagnosis in patients with post-micturition symptoms and paroxysmal hypertension, as well as the need for a multidisciplinary approach in the evaluation and management of such rare and complex cases. Early recognition and surgical intervention are crucial for optimal management and favorable clinical outcomes.

A case of large-cell undifferentiated carcinoma of the bladder.

Large-cell undifferentiated carcinoma of the urinary bladder is an extremely rare and aggressive neoplasm. We present a unique case of painless gross hematuria and a past surgical history of cystolithotomy. The patient underwent transurethral resection of the bladder tumor, which revealed high-grade urothelial cell carcinoma with lamina propria involvement. Subsequent radical cystoprostatectomy with orthotopic neobladder urinary diversion and pelvic lymphadenectomy was performed, and the postoperative pathologic examination indicated large-cell undifferentiated. This case report highlights the importance of accurate diagnosis and management for this rare malignancy and adds to the limited existing literature on Large-cell undifferentiated carcinoma.

Primary Urinary Bladder Tumors in Three Guinea Pigs (Cavia Porcellus).

Urinary bladder tumors are not common in guinea pigs, but case numbers being diagnosed have increased in the past years. The authors present 3 referred cases of primary urinary bladder tumors in pet guinea pigs diagnosed using diagnostic imaging (CT, radiography, and ultrasonography) and exploratory laparotomy. Excision was not possible in the first case as the tumor was located at the neck of the urinary bladder and the owner opted for intraoperative euthanasia. The second and third cases both had tumors originating from the apex of the urinary bladder. The third guinea pig went into cardiac arrest during surgery and resuscitation was unsuccessful. The tumor was removed from the urinary bladder using partial cystectomy in the second case and 1-month postsurgery ultrasonographic examination showed no signs of tumor reoccurrence. Late recognition is the main reason for a negative outcome, as by this time tumors are already large and extensive. Whenever prolonged symptoms of hematuria are present and urolithiasis has been ruled out, ultrasonography should be undertaken to determine if a urinary tumor is the cause. Rechecks should be scheduled on a regular basis for guinea pigs when a definitive diagnosis can not be made at the initial presentation for vague clinical signs, as outcome and survival can reduce significantly when definitive treatment is delayed.

Bladder paraganglioma after kidney transplantation: A case report.

BACKGROUND: Kidney transplantation is associated with an increased risk of tumors in the urinary bladder. Among all the pathological types of tumors in the bladder, paraganglioma, which arises from extra-adrenal paraganglia and consists of chromaffin cells, is rare. Paragangliomas might cause severe clinical symptoms due to catecholamine hypersecretion or mass compression. Bladder paragangliomas are rare, especially those appearing after kidney transplantation. Here, we report a case of bladder paraganglioma developing after kidney transplantation. CASE SUMMARY: A 63-year-old woman received a kidney transplant 12 years ago and took oral immunosuppressants (cyclosporine, mizoribine, and methylprednisolone) for regular post-transplant treatment. The patient felt no discomfort and she came to the hospital for a routine checkup. A mass located in the bladder was incidentally discovered by computed tomography, and she underwent surgical treatment. A 2 cm × 2 cm invasive mass was found in the trigone of the bladder and the mass was removed. The diagnosis of paraganglioma was confirmed by morphology and immunophenotyping. The patient had a good prognosis and is still alive. CONCLUSION: Paraganglioma can grow in the bladder, which might cause no clinical symptoms. The diagnosis mainly depends on morphology and immunophenotyping. Surgical resection is an important treatment option for such patients.

Primary Neuroendocrine Tumor of Urinary Bladder: A Case Report of an Unusual Occurrence.

Pheochromocytomas are tumors arising from catecholamine secreting cells of adrenal glands. Extra adrenal gland pheochromocytomas are called paragangliomas. They account for 15% of all pheochromocytomas. Paraganglioma arising in the urinary bladder is extremely rare accounting for 0.06% of all urinary bladder tumor cases. We present a case of a 55-year-old female patient who complained of pain in abdomen and intermittent haematuria subsequently. Magnetic resonance imaging (MRI) pelvis was done which gave the possibility of paraganglioma. An excision of bladder mass was done and sent for histopathology. On histopathology accompanied by immunohistochemistry, a final diagnosis of paraganglioma was given. The patient is on regular follow-up.

Clinical trajectory of a patient with filaminopathy who developed arrhythmogenic cardiomyopathy, myofibrillar myopathy, and multiorgan tumors.

We report a case of a patient presenting with arrhythmogenic cardiomyopathy, myofibrillar myopathy, and multiorgan tumors. A 41-year-old woman with a history of hypertrophic cardiomyopathy, diagnosed at 6 years of age, developed scoliosis after puberty. Following spinal surgery to address the scoliosis, she developed recurrent severe arrhythmia and heart failure. She developed hypoventilation at age 29 years. Proximal dominant weakness and mild elevation of serum creatine kinase indicated possible myopathy. Myofibrillar myopathy was diagnosed by muscle biopsy at age 30 year. Acute abdomen was repeatedly reported from age 33 years, eventually leading to a diagnosis of gastric polyp and erosive ulcer. A urinary bladder tumor was found at age 35 years, and breast cancer was diagnosed at age 40 years. Whole exome sequencing detected a heterozygous missense mutation in Filamin C. Recent evidences suggest that filamins are associated with tumors, and this case further highlights the clinical spectrum of filaminopathy.

Prolapsing inflammatory myofibroblastic tumor of the urinary bladder: A case report and a review of literature.

Inflammatory myofibroblastic tumor (IMT) of the urinary bladder is a rare soft tissue benign tumor usually presents with hematuria, dysuria or obstructive urinary symptoms. No distant metastasis has been reported except in a single case. There is no clear consensus on the management plan yet. However, complete surgical resection is the mainstay management. We reported a case of a female patient presented with a painless prolapsing urethral mass that bleeds of touch with no signs of local invasion or distant metastasis, complete resection and pathological evaluation of the specimen revealed an IMT. The postoperative period was uneventful for 1 year.

Miction-induced Hypertension Disclosed by Home Blood Pressure Measurement in a Patient with Small Paraganglioma.

A 46-year-old woman complained of a 10-year history of headache, nausea, a precordial oppressive feeling and shortness of breath on miction. She had noted a marked elevation in her blood pressure after miction using home blood pressure measurement. Her catecholamine levels were less than twice the value of the normal upper limit. Several imaging modalities detected a urinary bladder tumor, and 123I-metaiodobenzylguanidine scintigraphy showed positive accumulation. The diagnosis of urinary bladder paraganglioma was confirmed by partial cystectomy. We must keep in mind that paroxysms and hypertension associated with miction are important diagnostic clues of pheochromocytoma/paraganglioma. Home blood pressure measurement was very useful for detecting hypertension in this case.

Clinicopathological Characteristics of Urinary Bladder Tumors in Korean Patients 20 Years or Younger.

BACKGROUND: To investigate the clinicopathological characteristics of urinary bladder tumors, a rare malignancy, in patients 20 years or younger. METHODS: Using a retrospective chart review among patients who received bladder surgery at 2 institutions between July 1996 and January 2013, we analyzed the clinicopathological characteristics of urinary bladder tumors in 21 pediatric patients (male:female = 4.25:1.00; mean age, 12.1 years). RESULTS: Pathology revealed 9 urothelial tumors, 6 rhabdomyosarcomas, 1 low-grade leiomyosarcoma, 1 large cell neuroendocrine carcinoma, 1 inflammatory myofibroblastic tumor, and 3 cases of chronic inflammation without tumors (including 1 xanthogranulomatous inflammation). Urothelial tumors (mean patient age, 16.0 years) were benign or low-grade; and only transurethral resection of the bladder tumor was necessary for treatment. Patients with rhabdomyosarcomas (mean age, 5 years) underwent radiotherapy (if unresectable) or transurethral resection of the bladder tumor (if resectable), after chemotherapy. Of these patients, 2 underwent radical cystectomy, with the remaining patients not receiving a cystectomy. With the exception of one patient, all patients are currently alive and recurrence-free. CONCLUSION: Urothelial tumors were the most commonly found pediatric bladder tumor, with embryonal rhabdomyosarcoma being the second most common. Urothelial tumors are common in relatively older age. Since urothelial tumors in children typically have a good prognosis and rarely recur, transurethral resection of the bladder tumor is the treatment of choice. Rhabdomyosarcomas are common in younger patients. Since rhabdomyosarcoma is generally chemosensitive, chemotherapy and radiotherapy are the treatment of choice for bladder preservation in these patients.

[En-bloc laser resection of the urinary bladder tumor].

Currently, transurethral resection of a bladder tumor (TUR) is the gold standart treatment for non-muscle invasive bladder cancer (NMIBC). Standard TUR for a bladder wall tumor has a high recurrence rate, which is caused mainly by malignant cell implantation during the surgery. Besides, specimens obtained with conventional TUR are insufficient for accurate pathological staging. The non-conformity of the standard TUR with the established oncological principle of dissecting through normal tissue prompted a search for the optimal surgical modality. En-bloc resection of the bladder wall tumor has been proposed as an alternative method for surgical management of NMIBC. This technique involves the resection of bladder tumor through the underlying muscle layer as a single piece thus providing high quality material for subsequent morphological study and reducing the risk of metastasizing by implantation of malignant cells. This paper presents an analysis of relevant research literature published in the last twenty years, describes all currently existing techniques of the bladder tumor resection using a variety of energy sources, including laser.

Clinicopathological Characteristics of Urinary Bladder Tumors in Korean Patients 20 Years or Younger

BACKGROUND: To investigate the clinicopathological characteristics of urinary bladder tumors, a rare malignancy, in patients 20 years or younger. METHODS: Using a retrospective chart review among patients who received bladder surgery at 2 institutions between July 1996 and January 2013, we analyzed the clinicopathological characteristics of urinary bladder tumors in 21 pediatric patients (male:female = 4.25:1.00; mean age, 12.1 years). RESULTS: Pathology revealed 9 urothelial tumors, 6 rhabdomyosarcomas, 1 low-grade leiomyosarcoma, 1 large cell neuroendocrine carcinoma, 1 inflammatory myofibroblastic tumor, and 3 cases of chronic inflammation without tumors (including 1 xanthogranulomatous inflammation). Urothelial tumors (mean patient age, 16.0 years) were benign or low-grade; and only transurethral resection of the bladder tumor was necessary for treatment. Patients with rhabdomyosarcomas (mean age, 5 years) underwent radiotherapy (if unresectable) or transurethral resection of the bladder tumor (if resectable), after chemotherapy. Of these patients, 2 underwent radical cystectomy, with the remaining patients not receiving a cystectomy. With the exception of one patient, all patients are currently alive and recurrence-free. CONCLUSION: Urothelial tumors were the most commonly found pediatric bladder tumor, with embryonal rhabdomyosarcoma being the second most common. Urothelial tumors are common in relatively older age. Since urothelial tumors in children typically have a good prognosis and rarely recur, transurethral resection of the bladder tumor is the treatment of choice. Rhabdomyosarcomas are common in younger patients. Since rhabdomyosarcoma is generally chemosensitive, chemotherapy and radiotherapy are the treatment of choice for bladder preservation in these patients.

A novel fusion of HNRNPA1-ALK in inflammatory myofibroblastic tumor of urinary bladder.

Here, we report an inflammatory myofibroblastic tumor (IMT) of the urinary bladder with a novel HNRNPA1-ALK fusion. To the best of our knowledge, this is the first case of a tumor with HNRNPA1-ALK fusion. A 42-year-old Japanese man underwent total cystectomy because of an invasive urinary bladder tumor. Grossly, the tumor had invaded the peribladder fat tissue. Histologically, it comprised spindle neoplastic cells with intermingled inflammatory cells. Immunohistochemically, it was positive for ALK, SMA, desmin, cytokeratin, and vimentin, consistent with the immunohistochemical characteristics of IMTs. Fluorescence in situ hybridization demonstrated an ALK split, and the presence of HNRNPA1-ALK was revealed by RNA sequencing. We identified a novel transcript fusion of exon 2 of HNRNPA1 and exon 18 of ALK, resulting in ALK protein overexpression. These findings provide useful information on the biology and tumorigenesis of IMTs, thus facilitating the development of molecular-targeted therapeutics.

The Ewing's Sarcoma Family of Tumors of Urinary Bladder: A Case Report and Review of the Literature.

BACKGROUND: Only 15 cases of Ewing's Sarcoma (EWS) family of tumors of urinary bladder have been documented in the literature to date. CASE REPORT: We presented here a 38 year-old female with primary urinary bladder EWS with no distant metastases. She had presented with macroscopic hematuria and had undergone transurethral resection of the tumor within the following week. Microscopic examination revealed a tumor diffusely infiltrating the lamina propria and muscularis propria under an intact urothelium, which was composed of small round blue cells with scant cytoplasm, monotonous round or oval nuclei, stippled chromatin and small nucleoli. Immunohistochemistry showed strong vimentin, synaptophysin and membranous CD99 expression by the tumor. Fluorescent in situ hybridization analysis displayed the EWSR1 rearrangement. Radical cystectomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy, extended lymph node dissection, and ileal conduit were performed. As adjuvant chemotherapy, she received vincristine, doxorubicin, cyclophosphamide and mesna, alternating with courses of etoposide, iphosphamide and mesna. She is alive and well with no evidence of disease 14 months after the surgery. CONCLUSION: Surgery supported with chemotherapy should be considered as an option, especially in advanced Ewing's sarcoma family of tumors of urinary bladder.

Villous Tumor of the Urinary Bladder Resembling Low-grade Mucinous Neoplasm of the Appendix.

Mucinous neoplasms of the urinary tract are very rare. We present a 63-year-old-women who had a sessile papillary villous tumor in urinary bladder. Although transurethral resection of the bladder tumor (TURBT) was performed, the villous tumor repetitively recurred and gradually spread to the entire surface of bladder lumen. Histopathologic and immunohistochemical examination showed that the lesion was very similar to low-grade mucinous neoplasm arising in appendix vermiformis. There are no reports on appendiceal metaplasia of urinary bladder mucosa. In this case, we describe this unprecedented neoplasm as "villous tumor of the urinary bladder resembling low-grade mucinous neoplasm of the appendix."

Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial.

AIM: Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective in stopping adductor spasm during spinal anesthesia. METHODS: Forty-one patients undergoing (transurethral resection of bladder tumor) TUR-BT with spinal anesthesia who required (obturator nerve block) ONB were included in the study. After spinal anesthesia, ONB was performed with an inguinal approach (group 1) (n = 21) or an intravesical approach (group 2) (n = 20). In this study, we used 10 ml of 2 % lidocaine to perform the ONB. RESULTS: The mean age of patients was 60.8 ± 7.5 years. The groups were not different with regards to age, tumor localization and tumor size. There were two bladder perforations in group 1 and six perforations in group 2 (p = 0.130). However, the efficacy of ONB was significantly higher in inguinal approach group compared to intravesical approach group (p = 0.032). CONCLUSION: Obturator nerve block plays an additive role on the quality of analgesia for bladder surgery. Our data suggests that identification of the obturator nerve with ultrasound is easy and the block can be assessed by observing avoidance of bladder spasm.

TP53 intronic mutations in bovine enzootic hematuria-associated urinary bladder tumors.

Tumor protein 53 (TP53) is a tumor suppressor gene that is frequently mutated in urinary bladder tumors in both humans and animals. In cattle, urinary bladder tumors have been reported as occurring spontaneously as well as in conjunction with bracken fern consumption-induced bovine enzootic hematuria (BEH). The goal of this study was to evaluate various types of bovine urinary bladder neoplasms for the presence of TP53 alterations, using the polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) method. DNA was extracted from both epithelial and mesenchymal urinary bladder tumor samples in cattle, associated with the chronic consumption of bracken fern. PCR was performed using primers targeted to exons 5 to 8, following electrophoresis and isolation, and the products were assessed by SSCP. Tumors in which alterations in the electrophoresis patterns were noted included hemangiomas, papillomas, and carcinomas in situ. Exemplars of these tumor types were selected for sequencing, and although no changes were noted in the 5 to 8 exon range, on either side of the designed primers for exon 6, there was some portion of intron 6 in which sequencing demonstrated a deletion of the thyamine nucleotide at position 9332. In summary, although mutations were not observed within exons 5 to 8, this represents the first report of an intronic mutation in the TP53 gene in association with bovine urinary bladder tumors. Mutations within introns can predispose tissues to the development of cancer, and therefore, a possible association between mutations of the introns of TP53 and the development of urinary bladder tumors in cattle with BEH should be further investigated.

Study on inhibition of genistein on doxorubicin-resistant bladder tumor cells T24 / 肿瘤研究与临床

Objective To establish multi-drug resistant bladder (MDR) tumor T24 cell lines and to assess their resistant characteristics.To observe effect of genistein on doxorubicin (ADM) resistant cell lines T24/ADM.Methods Bladder tumor T24 cell line was exposed to ADM in the culture medium for the establishment of drug resistant cell lines:concentrations of ADM was stepwise increased for long exposure.Morphologic studies were performed with optical microscopy.Drug sensitivities were determined by MTT.Results Six months were taken to establish drug resistant cell lines T24/ADM.No obvious morphologic changes were observed between resistant and parental cell. But drug resistances to ADM, 5-Fu,cyclophosphamide and cisplatin were increased,and resistance index were 15.79,4.68,5.53 and 3.81,respectively.Among all groups,there were significant differences.After genistein was used to T24/ADM cells,the IC50 value of genistein was 40 μg/ml.The proliferation cells were induced by genistein at the concentration of 20-100 μg/ml. Conclusion Genistein can inhibit human urinary bladder cancer T24/ADM cell proliferation at some concentration.

The Diagnostic Value of Cystography with Low-concentration Contrast Medium in Diagnosing Small Tumor of Urinary Bladder / 实用放射学杂志

Objective To evaluate the value of cystography with low-concentration contrast medium in diagnosing small tumor of urinary bladder.Methods Cystography in 187 cases with bladder disease from 1992 to 2001 was performed using 6%～8% Meglumine Diatrizoate 100～120 ml under TV monitored.Radiogrames of A-P position and bilateral oblique position were taken when the focus was found.The radiogram on patient’s position at head low was adopted when necessary.Results Of 187 cases,106 cases of bladder tumors were detected,including 8 cases of small bladder tumor(≤1.0 cm in diameter),3 cases were misdiagnosed,the detectable rate was 73.0%.All cases were confirmed by operation and pathologiy.In these 8 cases,1 case was adenocarcinoma,5 cases were transitional epithelia cell carcinoma,2 cases were papilloma.The X-ray appearances were nipple-like or cauliflower shape with filling defect,a narrow pedicel could be occasionally found in papilloma or transitional epithelia cell carcinoma and it had somewhat movement when changed patient’s position.Conclusion Cystography with low-concentration contrast medium is a non-injury procedure in diagnosis of small tumor of urinary bladder.

Pathological Observation on 90 Cases of Bladder Transitional Cell Carcinoma and Its Prognosis / 第三军医大学学报

Ninety specimens of pathologically confirmed transitional cell carcinoma of the urinary bladder were studied. The patients consisted of 71 male and 19 female with a male/femai ratio of 3.5:1. Their age was ranged from 32 to 79. 12 specimens were studied with electron microscope. The histopathological and ultrastructural features of transitional cell carcinoma were described. Our fol-lowup data of the cases revealed that the larger a tumor,the lower its differentiation, the deeper its invasion, and the more extensive the involvement of lymphatic and blood vessels, the poorer the prognosis of the tumor. In addition the ultrastructural characteristics of transitional oell carcinoma were briefly discussed.