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Pathology of Paraganglioma of the Urinary Bladder


 Dr Sampurna Roy MD         



Glenner and Grimley (1974) set out the distribution of paragangliomas.

The chances of malignancy are higher when the site is extra-adrenal and vary from site to site.

Phaeochromocytoma (Paraganglioma) of the bladder are rare neoplasms, constitute less than 0.06% of all vesical tumours  with characteristic histologic and immunohistochemical features.

Microscopic sections can demonstrate what appears to be invasion of muscularis propria of the bladder wall, but on this basis alone the tumor should not be regarded as malignant. Other areas show the anastomosing or twisted cell cord pattern. 

It may be misdiagnosed as urothelial cancer because of :

1) Its frequent involvement of the muscularis propria;

2) Morphology that may suggest urothelial cancer in transurethral resection specimens, particularly if there are artifactual changes induced by that procedure;

3) Failure of pathologists to include it in their differential diagnosis when evaluating a bladder tumor; and

4) Only a minority of the cases are associated with symptoms that might prompt consideration of the diagnosis.

Distinction between paraganglioma and urothelial cancer is important because of likely different therapeutic options.

The diagnosis that the tumour is a paraganglioma rather than transitional cell carcinoma comes from the absence of associated dysplasia in the overlying transitional epithelium and the finding of dense core neuroendocrine granules at electron microscopy and typical immunohistochemical findings.

Common presenting features of this tumour include episodes of sweating, hypertension, haematuria, headache, palpitation, anxiety and in some cases post-micturition syncope.


Carotid Body Tumour ; Adrenal Pheochromocytoma ; Extra-adrenal Paraganglioma  ; Duodenal Gangliocytic Paraganglioma ; Cardiac Paraganglioma ; Pulmonary Paraganglioma ; Jugulotympanic Paraganglioma.


Further reading:

Locally advanced paraganglioma of the urinary bladder: a case report

Urinary Bladder Paraganglioma presenting as Micturition-Induced Palpitations, Dyspnea, and Angina

Urinary bladder malignant paraganglioma with vertebral metastasis: a case report with literature review

Pheochromocytoma of the urinary bladder: a systematic review of the contemporary literature

Non-functioning paraganglioma of the urinary bladder: A case report and review of the literature

Paraganglioma of Urinary Bladder Managed by Laparoscopic Partial Cystectomy in Conjunction with Flexible Cystoscopy: A Case Report

Paraganglioma of the urinary bladder: a lesion that may be misdiagnosed as urothelial carcinoma in transurethral resection specimens.

Malignant paraganglioma of the urinary bladder: Immunohistochemical study of prognostic indicators.

Identification of succinate dehydrogenase-deficient bladder paragangliomas.

Malignant paraganglioma of the urinary bladder in a 44-year-old female: clinicopathological and immunohistochemical study of a rare entity and literature review.



Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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