URINARY BLADDER PARAGANGLIOMA- A NOTEWORTHY, RARE ENTITY.

Urinary Bladder paraganglioma accounts for 0.06% of all bladder tumors and 1% of all pheochromocytoma. Most tumors are localized at the dome or trigone and are unifocal. The presenting complaints are painless hematuria, micturition syncope. It may be sporadic or associated with hereditary predisposition syndromes such as Hereditary Paraganglioma-Pheochromocytoma Syndrome. Case report: A 70-year-old male presented with complaints of hematuria. The physical examination was unremarkable. The CT scan revealed an enhancing mass in the lateral wall of bladder. The mass was resected, and histopathological examination showed features of tumor cells arranged in Zell ballen pattern. Tumor cells show mild nuclear pleomorphism, round to oval vesicular nuclei, prominent nucleoli and moderate to abundant granular basophilic cytoplasm. Rare mitosis and no necrosis were noted. On immunohistochemistry, tumor cells were immunoreactive to Synaptophysin, S-100P and negative for CK7 suggesting Paraganglioma. The patient is doing fine after two years of follow up. Due to its rarity, there are no recommendations for treatment and monitoring but, their risk of malignancy forces a long-term follow up. Initial management included early reassessment by cystoscopy, transurethral bladder resection (TURB) and imaging.