title: Urinary bladder paraganglioma presenting as micturition-induced palpitations, dyspnea, and angina.
abstract: BACKGROUND
  Sympathetic urinary bladder paragangliomas are rare catecholamine-secreting neuroendocrine tumors arising from neural crest cells. They are uncommon urinary bladder neoplasms. Symptoms classically include micturition-related or unrelated palpitations and syncope with hypertension, headaches, diaphoresis, and hematuria. Other than being attributable to vasovagal reactions, micturition-induced cardiovascular symptoms should prompt a search for catecholamine-secreting tumors such as a urinary bladder paraganglioma, as in this case.
  
  
  METHODS
  A 45-year-old asthmatic African-American female presented with episodic hematuria that began 4 years ago and episodes of micturition-induced palpitations, dyspnea, substernal tightness, sweating, and throbbing headaches. Computed tomography with contrast revealed an enhancing mass along the anterior urinary bladder wall, measuring 2.4×3.5 cm. On Positron emission Tomography with [18F] fluorodeoxyglucose integrated with computed tomography (18F-FDG PET/CT), the urinary bladder mass was 18F-FDG avid. Serum normetanephrine and supine plasma norepinephrine were significantly elevated and there was mild elevation of supine plasma epinephrine. Transurethral resection of the bladder mass revealed a neoplasm with microscopic features and immunohistochemical profile positive for synaptophysin and chromogranin, with negative screening cytokeratin AE1/AE3, suggesting a paraganglioma. Following resection of the paraganglioma, there was complete resolution of micturition-induced cardiovascular symptoms on long-term follow-up.
  
  
  CONCLUSIONS
  Micturition-related cardiovascular symptoms are commonly attributed to vasovagal reactions. However, urinary bladder pathologies must be ruled out as a cause, as in this rare case of a urinary bladder paraganglioma exhibiting catecholaminergic symptoms.
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA.
authors.forename: Arindam
authors.initials: A
authors.lastname: Bagchi
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA.
authors.forename: Kola
authors.initials: K
authors.lastname: Dushaj
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA.
authors.forename: Anup
authors.initials: A
authors.lastname: Shrestha
authors.affiliation: Department of Pathology, Icahn School of Medicine at Mount Sinai/Elmhurst Hospital Center, Elmhurst, NY, USA.
authors.forename: Anatoly L
authors.initials: AL
authors.lastname: Leytin
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA.
authors.forename: Shamsul A
authors.initials: SA
authors.lastname: Bhuiyan
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, USA.
authors.forename: Farshid
authors.initials: F
authors.lastname: Radparvar
authors.affiliation: Department of Nuclear Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Topchik
authors.affiliation: Department of Radiology, Ichan School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA.
authors.forename: Sandeep Singh
authors.initials: SS
authors.lastname: Tuli
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Kim
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, Jamaica, NY, USA.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Bakshi
mesh_terms: D000787:Angina Pectoris / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010235:Paraganglioma / Q000150:complications* / Q000175:diagnosis; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000175:diagnosis; D014554:Urination