A rare case report of urinary bladder paraganglioma initially misdiagnosed as a psychiatric disorder.

Introduction and importance: Bladder paraganglioma is a rare neuroendocrine tumor, accounting for less than 0.06% of all bladder tumors. Due to its nonspecific symptoms, it is frequently misdiagnosed, leading to delays in appropriate management. Case presentation: We report a case of a 45-year-old female who presented with post-micturition palpitations, diaphoresis, hypertensive episodes, and chronic lacunar infarcts for several years. Initially misdiagnosed with an anxiety disorder and later migraine with generalized anxiety disorder, her symptoms persisted despite psychiatric and neurological treatments. Further evaluation with ultrasonography and CT-intravenous urography revealed a bladder mass, prompting surgical intervention. Histopathology confirmed bladder paraganglioma with classic Zellballen architecture, and immunohistochemistry showed positivity for chromogranin A, synaptophysin, and CD56. Clinical discussion: Bladder paragangliomas are frequently mistaken for other bladder neoplasms or functional disorders due to their variable presentation. Imaging plays a crucial role in diagnosis, but definitive confirmation relies on histopathology and immunohistochemistry. Surgical excision remains the gold standard for treatment, with long-term follow-up necessary due to the potential for recurrence. Conclusion: This case highlights the diagnostic challenges of bladder paraganglioma, emphasizing the need for a high index of suspicion in patients presenting with unexplained hypertensive crises or post-micturition symptoms. Early recognition and appropriate management are essential for optimal patient outcomes.