Urinary Bladder and Left Hypogastric Artery Paraganglioma. A Case Report and Literature Review

Objective: We report the case of a 77-yeard old female with history of urinary bladder paraganglioma that during follow-up was diagnosed with a tumor in the left hypogastric artery. Introduction: Paragangliomas are tumors that can be found in the cervical, thoracic, and abdominal spaces. Distal locations surrounding arterial structures such as the aortic bifurcation or iliac arteries are rare, as is the involvement of other pelvic organs like the urinary bladder. Iliac artery and urinary bladder paragangliomas can be considered as paragangliomatosis, or metastasis of each other. The preferred study to locate the non-adrenal paraganglioma is Magnetic Resonance Imaging (MRI). Stage T2 has an excellent definition of size, vascular relationship and metastasis location, being sensible up to 100%. Scintigraphy using I-131-metaiodobenzylguanidine (I-MIBG) has a sensibility of 95% and specificity of 100%, useful at metastasis detection. Surgical resection is the preferred treatment. Pre-operative preparation involving imaging study and pre-medication is vital to avoid hypertensive crisis or vascular collapse due to ceased catecholamine production, as most tumors are functional. Discussion: Being a rare disease there is no standard surgical approach; partial or radical cystectomy, with lymphadenectomy, is recommended depending on size, location and surrounding tissue involvement. Conclusion: Determination of catecholamine levels is vital in asymptomatic patients. Levels of metanephrines serum is the most sensitive and specific test. Genetic study in multiple paraganglioma is mandatory. MRI is the preferred location study.