Nephroquiz 8: Perioperative Management of Paraganglioma

A 32-year-old woman was admitted because of severe uncontrolled hypertension associated with intermittent headache, diaphoresis, and blurred vision. She had a 3-year history of hypertension. Her symptoms were worsened by urination. Physical examination revealed a blood pressure of 155/120 mm Hg and bilateral papilledema. The tilt test was negative. Bruit over the renal artery was not audible. Laboratory examinations are shown in the Table. Abdominopelvic computed tomography showed lymphadenopathy in the celiac region and a 23-mm enhancing lesion in the bladder floor. No mass lesions were seen in the adrenal glands. Abdominopelvic magnetic resonance imaging confirmed computed tomography findings (Figure 1). Metaiodobenzylguanidine scan was negative. A 2.5 × 2.5 × 1-cm mass was completely removed laparoscopically. Pathologic report concluded urothelial mucosa with submucosal neoplasm composed of monomorphic polygonal cells with central round nuclei. Fine speckled chromatin and marked nucleoli as well as granular eosinophilic cytoplasm arranged as nest formation. No obvious mitotic figures were seen. Diagnosis of paraganglioma was confirmed with chromogranin and synaptophysin immunohistochemical staining (Figure 2).