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      Pheochromocytoma: A Cause of Anemia

      case-report
      ,
      Urology Case Reports
      Elsevier
      Pheochromocytoma, Urinary bladder, Vesical, Anemia

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          Abstract

          Patients with a Pheochromocytoma usually present with intractable hypertension, postural hypotension, headaches and palpitations, with intractable hypertension being the predominant symptom. When the tumor is located in the urinary bladder, symptoms may be induced by micturition. Herein, we report a young patient with a urinary bladder Pheochromocytoma without hypertension or symptoms induced by micturition. Instead, she presented with anemia.

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          Non-Functional Paraganglioma of the Urinary Bladder Treated by Transurethral Resection: Report of Two Cases.

          Paraganglioma of the urinary bladder is a rare tumour derived from chromaffin tissue of the sympathetic nervous system. Paraganglioma of the urinary bladder especially the non-functional type is often misdiagnosed as urothelial cancer. Two female patients aged 32 years and 45 years presented with painless haematuria without any symptoms of catecholamine excess. Radiological investigations revealed urinary bladder tumour. The tumour was removed by transurethral resection in both the patients. Histopathological diagnosis was paraganglioma, which was confirmed by immunohistochemistry. Complete resection of tumour by transurethral approach is curative in paraganglioma of the urinary bladder. We hereby, also discuss the salient features of nonfunctional paraganglioma of the urinary bladder.
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            Clinicopathological study of pheochromocytoma of the urinary bladder: immunohistochemical, flow cytometric and ultrastructural findings with review of the literature.

            Pheochromocytomas usually arise from the adrenal medulla but may also arise from the carotid body, the retroperitoneum, the urinary bladder, and other locations. We report three cases of pheochromocytoma of the urinary bladder with clinicopathological, immunohistochemical, flow cytometric, and ultrastructural findings. Case 1, a 13-year-old boy presented with hematuria. He underwent partial cystectomy, 31 years later he presented with a tumor in the thoracic vertebra. Case 2, a 35-year-old woman presented with headache, nausea, vomiting, palpitations, and diaphoresis on evacuation. She underwent total cystectomy and regional lymph adenectomy. She survived for 10 years without recurrence or metastasis; however, she died from another disease. Case 3, a 31-year-old man presented with dysuria. He underwent total cystectomy and regional lymph adenectomy. The tumor metastasized to the lymph nodes, and the patient died after 4 years. The urinary bladder tumors in these three cases protruded into the lumen and invaded deeper than the middle of the muscle layer. The tumor of the urinary bladder, metastatic lymph nodes, and thoracic vertebra showed alveolar and trabecular patterns, and tumor cells were surrounded by capillaries. The tumor cells were moderate in size with ovoid nuclei and abundant eosinophilic cytoplasm that contained acidophilic granules reactive to Grimelius stain. Vascular invasion was observed in cases 1 and 2. Immunohistochemically, tumor cells showed reactivity for chromogranin, Leu 7, and S-100 protein. In each of the three cases, the DNA ploidy pattern on flow cytometry was aneuploid. Ultrastructural examination revealed several neurosecretory granules, rough endoplasmic reticulum, and a few mitochondria within the cytoplasm. It is difficult to determine whether pheochromocytoma of the urinary bladder is malignant on the basis of histological, immunohistochemical, and flow cytometric findings. Long-term follow up is necessary.
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              Malignant pheochromocytoma of the bladder.

              S. Das, P Lowe (1980)
              A review of malignant pheochromocytoma of the bladder is presented with an illustrative case, emphasizing the importance of preoperative localization and an extirpative surgical approach for such patients. Since histologic criteria of malignancy in phoechromocytomas have not yet been established all of these patiets warrant a thorough intraoperative search and long-term postoperative followup for possible metastases.
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                Author and article information

                Contributors
                Journal
                Urol Case Rep
                Urol Case Rep
                Urology Case Reports
                Elsevier
                2214-4420
                28 January 2017
                February 2017
                28 January 2017
                : 11
                : 53-54
                Affiliations
                [1]QEQM Hospital, East Kent Hospitals University NHS Foundation Trust, Margate, UK
                Author notes
                []Corresponding author. adhamyoussef@ 123456doctors.org.uk
                Article
                S2214-4420(16)30118-8
                10.1016/j.eucr.2016.12.005
                5279738
                1d712858-85bb-40ad-ad00-08fc9e3eeb4b
                Crown Copyright © 2017 Published by Elsevier Inc.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 17 August 2016
                : 15 December 2016
                Categories
                Oncology

                pheochromocytoma,urinary bladder,vesical,anemia
                pheochromocytoma, urinary bladder, vesical, anemia

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