Acute bladder retention secondary to bladder paraganglioma in an 86-year-old female: case report

Clinical case: an 86-year-old female comes for medical evaluation during an episode of acute urinary retention, upon medical questioning she only reffers previous events of nonspecific chills and malaise; after an urotomography is ordered, an exophytic lesion was identified in the bladder wall. Cystoscopy was performed with resection of the lesion, further inmunohistochemical analysis helped make the diagnosis of sympathetic bladder paraganglioma. Absent catecholamines were found at follow-up. Relevance: bladder paragangliomas are extraordinarily rare, with an estimated incidence of 0.6-0.8 cases per 100,000 person-years. When located in the abdomen, it affects the organ of Zuckerkandl in 70 % of cases; the bladder is involved in only 10 % of cases of intra-abdominal paraganglioma. Clinical implications: the cyclic secretion of catecholamines, originated by the neoplastic cells that compose the paraganglioma, causes systemic symptoms related to their activity in other organs. The clinical presentation of sympathetic bladder paragangliomas can be highly insidious, due to the wide range of local and systemic symptoms that can be observed. Conclusions: due to the local effect of the neoplasm or its catecholamine-secreting activity, the index of suspicion for this type of neoplasm should be high and coupled with a detailed anamnesis to identify the catecholamine-related signs and/or symptoms.