Indian Journal of Urology
CASE REPORT
Year
: 2001  |  Volume : 17  |  Issue : 2  |  Page : 177--178

Pheochromocytoma of the urinary bladder


AR Jayadeva, Vijaya Kumar, V Sivakumar, AY Lakshmi, CK Reddy, G Gopalakrishnan 
 Departments of Uro-Nephrology and Radiology, Sri Sathya Sai Institute of Higher Medical Sciences (SSSIHMS), Andhra Pradesh, India

Correspondence Address:
A R Jayadeva
Department of Uro-Nephrology, SSSIHMS, Prashanthi Gram - 515134, Anantapur Dt., Andhra Pradesh
India




How to cite this article:
Jayadeva A R, Kumar V, Sivakumar V, Lakshmi A Y, Reddy C K, Gopalakrishnan G. Pheochromocytoma of the urinary bladder.Indian J Urol 2001;17:177-178


How to cite this URL:
Jayadeva A R, Kumar V, Sivakumar V, Lakshmi A Y, Reddy C K, Gopalakrishnan G. Pheochromocytoma of the urinary bladder. Indian J Urol [serial online] 2001 [cited 2019 Jul 16 ];17:177-178
Available from: http://www.indianjurol.com/text.asp?2001/17/2/177/21059


Full Text

 Introduction



Pheochromocytoma is a neoplasm of chromaffin tissue of the sympathetic nervous system mostly arising from the adrenal medulla. About 10% of pheochromocytomas arise from the extra-adrenal sites. Urinary bladder pheo­chromocytoma is a rare entity constituting less than 0.6% of all bladder neoplasms. We report one such entity in a patient with review of recent literature. [1],[2],[3],[4]

 Case Report



45-year-old male presented with a history of palpitation, syncope at times and tiredness after micturition for 3 years. He manifests episodic hypertension during these attacks. There is no family history of hypertension, neurofibromato­sis and phaeochromocytoma. Clinical examination revealed episodic hypertension at the time of the act of micturition with normotension in between. Systemic examination includ­ing cardiovascular, respiratory, endocrinal and abdominal examination was unremarkable.

Investigations revealed haemoglobin, WBC count, blood sugar, blood urea and serum creatinine being within nor­mal limits. The 24-hours' urinary Vanilyl Mandelic Acid (VMA) was more than 7 mg/day (Normal 2 to 7 mg/day). Ultrasound study showed a mixed echogenic mass of 6.6 x 5.3 cms arising from the bladder base. Kidneys were normal. There was no suggestion of urinary tract obstruc­tion. Spiral Computed Tomography (CT) of the abdomen and pelvis showed a non-homogeneous mass with low den­sity areas arising from the bladder base, the size being 6.7 x 5.4 cms with a Hounsfield value of 30 [Figure 1]. The mass was enhancing with contrast. There was no evidence of invasion. The kidneys and adrenals were normal and there was no suggestion of regional lymph node enlargement. X­Ray chest was normal. Cystourethroscopy revealed that the mass was arising from trigone. Surgical excision of the tu­mour was performed after thorough control of hyperten­sion with alpha and beta blockers. Histopathology confirmed the tumour as chromaffin paraganglioma of the urinary blad­der. Patient completed about 2 years of recurrence-free post­operative period confirmed by repeat computed tomography of urinary system being normal, urinary VMA in normal range and no abnormality in urethrocystoscopy.

 Discussion



Phaeochromocytoma of the urinary bladder is a rare entity constituting less than 0.5% of all the vesical neoplasms. It arises from the embryonic crest of the chromaffin cells in the sympa­thetic plexus of the vesical wall. Vesical phaeochromocytoma commonly presents with hypertension, haernaturia and micturitional attacks. The tumour is usually submucosal or intramural with intact vesical epithelium, the most common location being trigone. The peak incidence of presentation is usually in the 2 nd decade with female to male ratio of 3:2. UI­trasonography, CT, Magnetic Resonance and Scintigraphic studies are useful noninvasive modalities for the detection and spread of the tumour.

In our patient, the symptoms of micturitional attacks with episodic hypertension, ultrasound and CT study suggestive of a tumour in the bladder with high urinary VMA were sugges­tive of bladder pheochromocytoma. The histopathology of the tumour confirmed the same. The patient completed about 2 years of symptom and recurrence-free period evaluated by clini­cal, biochemical, CT study and urethrocystoscopy.

References

1Ochi K, Yoshioka S, Morita M, Takeuchi M. Pheochromocytoma of bladder. Urology 1983; 22: 228-230.
2Das S, Bulusu NV, Lowe P. Primary vesical pheochrornocytoma. Urology 1983; 21: 20-25.
3Sweester PM, Thompson NW. Pheochromocytoma of the urinary bladder. Surgery 1991: 109: 677-681.
4Rajaratnam S, Sheshadri MS, Gopalakrishnan G. Chandi SM. Pheo­chromocytoma of the urinary bladder. J Assoc Physicians India 1999; 47: 246-247.