Aggressive Paraganglioma of the Urinary Bladder with Local Recurrence and Pelvic Metastasis
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LETTER TO THE EDITOR
Aggressive Paraganglioma of the Urinary Bladder with Local Recurrence and Pelvic Metastasis Koo Han Yoo 1,2
&
Taesoo Choi 2 & Hyung-Lae Lee 2 & Min Jeong Song 3 & Benjamin I Chung 1
Received: 20 May 2020 / Accepted: 10 June 2020 # Arányi Lajos Foundation 2020
Abstract Many pheochromocytoma and extra-adrenal paraganglioma are benign, but some are malignant. Pheochromocytoma of the Adrenal gland Scaled Score analyzed the histological characteristics of the tumor. Tumors with a Pheochromocytoma of the Adrenal gland Scaled Score of 4 or higher have a higher risk of recurrence. This pattern is thought to be applicable to paraganglioma as well, and to future patient follow-up efforts. We report a recurrent and metastatic paraganglioma of the urinary bladder. Keywords Paraganglioma . Urinary bladder . Neoplasm metastasis
Pheochromocytoma and extra-adrenal paraganglioma are identical diseases that occur in neural crest tissues and are named differently depending on their anatomical location [1]. The World Health Organization (WHO) decided to assign pheochromocytoma exclusively for tumors occurring in the adrenal medulla, and defined extra-adrenal paraganglioma as tumors occurring in other tissues. Patients with pheochromocytoma and extra-adrenal paraganglioma complain of symptoms (e.g., high blood pressure, headache, sweating, tremor, palpitations, and pale face). The cause of these symptoms is excessive catecholamine secreted by the tumor. These symptoms occur when excessive catecholamines are released through excessive physical exertion, labor, anesthesia, surgery, or urination. Such excessive catecholamine secretion can be utilized in diagnosis. Using plasma-free fractionated metanephrine in 24-h urine, the diagnostic rate reports low sensitivity (77%–90%) but a high specificity (98%) [2]. In addition, computed tomography (CT) or magnetic resonance imaging can confirm the anatomical
* Koo Han Yoo [email protected] 1
Department of Urology, Stanford University Medical Center, Stanford, CA, USA
2
Department of Urology, School of Medicine, Kyung Hee University, 892, Dongnam-ro, Gangdong-gu, Seoul 05278, South Korea
3
Department of Pathology, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul 05278, South Korea
location of the tumor as well as the tumor size and contrast. Recently, iodine I 123 - metaiodobenzylguanidine scintigraphy has been utilized for diagnosis with improved sensitivity (80– 90%) and specificity (95–100%). Surgical treatment is the principle treatment for pheochromocytoma and paraganglioma [3]. However, preoperative treatment such as phenoxybenzamine (a nonselective alphaantagonist) is required to suppress excessive catecholamine secretion. Metastatic or recurrent pheochromocytoma, and extra-adrenal paraganglioma require further treatment after surgery. Palliative therapy that can be selected after removal of all visible tumors can be considered for chemotherapy, target therapy, or radiation therapy. Chemotherapy is difficult to prolong survi
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