Analysis of diagnosis and treatment of 17 patients with urinary bladder paraganglioma
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摘要: 目的 探讨膀胱副神经节瘤(urinary bladder paraganglioma，UBPGL)的术前诊断和治疗分析。方法 回顾性分析2015年1月—2021年12月海军军医大学第一附属医院共17例UBPGL患者的临床表现、影像学特征、手术和病理、预后等资料。结果 男10例，女7例；年龄41~87岁，平均(61±12)岁。7例体检发现，5例无痛性血尿，1例血尿伴腹痛，3例膀胱刺激征，1例排尿后头晕。5例既往有高血压病史。术前11例行影像学检查，其中9例CT增强检查，2例MRI增强检查。8例类圆形，3例分叶状。10例边界清晰，1例边界模糊。9例CT平扫呈等密度，增强后明显强化。3例钙化。3例囊变。2例T1WI均呈高信号，T2WI分别呈高信号和等信号，弥散均受限，增强后呈明显强化。13例行经尿道膀胱肿瘤电切术，2例行腹腔镜下膀胱部分切除术，1例行开腹膀胱部分切除术，1例行开腹全膀胱及右肾输尿管切除术。术后病理显示17例病灶大小8~89 mm，中位数20 mm。17例均为单发，4例位于右壁，5例位于左壁，5例位于后壁，前壁、上壁、下壁各1例。13例腔内生长，3例腔外生长，1例跨壁生长。11例为宽基底，4例为窄基底，2例带蒂。1例侵犯前列腺和右侧输尿管，盆腔淋巴结转移；1例左侧盆腔淋巴结转移。2例患者失访，15例患者术后随访时间为4~84个月，14例未复发，1例术后1年死亡。结论 UBPGL多数患者临床症状不典型，影像学特征为增强后明显强化，行手术治疗后整体预后较好。Abstract: Objective To investigate the preoperative diagnosis and clinical management of urinary bladder paraganglioma (UBPGL).Methods We retrospectively enrolled 17 patients with pathologically confirmed UBPGL in First Affiliated Hospital of Naval Medical University between January 2015 and December 2021. The clinical characteristics, imaging features, surgical approaches, pathology and prognosis were described and analyzed.Results A total of 10 males and 7 females were enrolled, with an average age of (61±12) years (range, 41-87 years). Among them, 7 patients were found by physical examination, 5 patients had painless hematuria, 1 patient had hematuria with abdominal pain, 3 patients had bladder irritation sign, 1 patient experienced dizziness after urination. Five of all patients had history of hypertension. Nine patients underwent contrast enhanced CT examination while 2 patients underwent contrast enhanced MRI examinations before surgery. Most of the tumors grew with oval shapes (n=8) and well defined margins (n=10). CT showed homoattenuation and marked enhancement in nine lesions. Calcification could be found in 3 lesions. Intratumor cystic degeneration was observed in 3 lesions. Two lesions with MRI showed hyperintensity on T1-weighted images, hyperintensity and homointensity on T2-weighted images, hyperintensity on diffusion-weighted images (DWI) and marked enhancement. All cases underwent surgery, including 13 cases with transurethral resection of bladder tumor, 2 cases with laparoscopic partial cystectomy, 1 case with open partial cystectomy and 1 case with open total cystectomy and right nephroureterectomy. Postoperative pathology showed that tumor diameters ranged from 8 to 89 mm, with a median of 20 mm. Four lesions were located in the right wall of bladder, 5 lesions were located in the left wall, 5 lesions were located in the posterior wall, and the rest were located in the anterior, dome and bottom wall respectively. Most lesions grew into the bladder cavity (n=13). One lesion invaded the prostate and right ureter with pelvic lymph node metastasis. One case had left pelvic node metastasis. Two patients were lost to follow-up whereas 15 patients were followed up for 4-84 months, including 14 patients without recurrence and 1 patient who died 1 year after operation.Conclusion Most patients with UBPGL have atypical clinical symptoms. Marked enhancement is the most important imaging feature of UBPGL. The overall prognosis of patients is good after surgery.
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Key words:
- urinary bladder /
- paraganglioma /
- diagnosis /
- imaging /
- treatment
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