PMC5791395_01
Contrast enhanced magnetic resonance imaging showing paraganglioma on the posterior bladder wall (arrow).
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MRI identified a 5x5x3 cm mass in the posterior bladder wall (Figure 1).
Paraganglioma visualised on the posterior bladder wall involving the trigone. Margins for resection are marked using cautery. LVUJ - left vesico-ureteric junction, RVUJ - right vesico-ureteric junction.
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Visual cues from three-dimensional magnified vision of the endoscope were used to mark macroscopic tumour margins with cautery (Figure 2).
Bladder outlet reconstructed following re- resection and negative surgical margins on frozen section.
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New Jersey, USA) (Figure 3). Next, the tumour free margins of the bladder were closed primarily using 3-0 V-Loc (Covidien Ltd., Dublin, Ireland) sutures.
Ureteric re-implantation performed according to classical technique described by Politano-Leadbetter by creating a submucosal tunnel (arrow). LFT - left fallopian tube.
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Both ureters were then re-implanted using the classical technique described by Politano-Leadbetter with two separate incisions on the lateral surface of bladder (Figure 4).
Postoperative cystogram showing normal contour of bladder and absence of contrast extravasation.
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The urinary catheter was removed on the 10th postoperative day following cystogram (Figure 5).
Final histopathologic examination. A) Paraganglioma cells (arrow) dissecting the bladder muscle (M). B) Immunohistochemistry staining of paraganglioma cells positive for chromogranin A growing between smooth muscle cells (M) of the bladder wall.
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Final histopathological analysis confirmed a non- malignant type of paraganglioma with cells positive for synaptophysin, chromogranin, CD56 and S100 on immunohistochemistry (Figure 6) with tumour free margins.