Urinary bladder pheochromocytoma, an extremely rare tumor in children: case report and review of the literature

Abstract

We report a case of pheochromocytoma in the urinary bladder of a 14-year-old girl who presented with headache and palpitation after voiding. This is an extremely rare condition in pediatric age group and thus can be missed easily. This case is the seventh case reported in the reviewed literature.

Unusual Bladder Mass in a 14-Year-Old Boy: Bladder Paraganglioma

“…Thirty percent of the pheochromocytoma involves the chromaffin tissue of Zuckerkandl's organs of the head, neck and thorax, as extra-adrenal localization (paraganglioma). Bladder neoformations in pediatric age are rare entities, and include neurofibroma, rhabdomyosarcoma, transitional cell carcinoma, leiomyosarcoma, neuroblastoma and paraganglioma, the latter accounting for 0.06% of all bladder tumors [2,4,5] .…”

“…Few cases of paraganglioma of the urinary bladder have been reported [1,2] . It is a rare entity that usually presents with the triad of hypertension, hematuria and post-micturition syncope, by catecholamine production.…”

“…Surgical resection is the treatment of choice, but preoperative treatment with ␣ -and ␤ -blocking agents is required, starting 1-3 weeks before surgery, to avoid hypertensive crisis during the mass manipulation [1][2][3] . Due to the multilayer involvement of the bladder wall, partial cystectomy by open surgery is recommended.…”

“…Thus, long-term follow-up is required, by monitoring of blood pressure, annual 131 I-MIBG nuclear scan and determination of urinary and blood catecholamines and metabolites [2] .…”

Headache in Pheochromocytoma

“…(10)(12-14) It usually occurs spontaneously, but recurrent severe headaches may occur after voiding in patients with bladder pheochromocytoma. (13,15) An important feature of the paroxysmal headache is its short duration. In 50% of patients it lasts for less than 15 minutes, and in 70% its duration is less than one hour.…”