膀胱Paragangliomaの1例

Abstract

65歳女.53歳時に高血圧を指摘された.排尿後に生じる発作的な頭痛, 動悸, 冷汗を自覚した.橈骨動脈にカテーテルを留置し, 排尿前後の血圧変動測定および内分泌学的検査を施行した.131I-MIBGシンチグラフィーを施行し, 膀胱paragangliomaと診断した.カルデナリン, テノーミンで血圧をコントロールした後, 膀胱腫瘍摘出術を施行した.骨盤内リンパ節の腫大は認めなかった.病理組織学的により膀胱paragangliomaと診断した.術後, 排尿後発作は消失した.内分泌学的検査にて血中, 尿中カテコラミンは正常範囲となった.術後4ヵ月経過したが, 再発は認めていない

A patient with paraganglioma of the urinary bladder is reported. A 65-year-old woman was referred to our hospital with the chief complaint of postvoiding headache, palpitation, and cold sweat. She had has no episodes of hematuria. On laboratory data, mild elevation was found in plasma neuron specific enolase (NSE), urinary noradrenaline and urinary metanephrine. The patient showed hypertension after urination with the elevation of plasma noradrenaline. 131I-MIBG scintigraphy showed abnormal accumulation in the bladder, and no abnormal accumulation in the other lesion. Pelvic magnetic resonance imaging (MRI) revealed a solid tumor of the urinary bladder, measuring 2 cm in diameter. Paraganglioma of the urinary bladder was diagnosed and the tumor was extirpated. The tumor measured 2 x 2 x 1.5 cm, and histopathologically diagnosed as paraganglioma. After extirpation, the patient became free of the postvoiding symptoms, and showed normal catecholamine levels. She has been followed up for 4 months after operation without any evidence of recurrence.