Muscle-Invasive Bladder Paraganglioma: Case Report and Comprehensive Literature Review.

Bladder paragangliomas are rare neuroendocrine tumors that represent a minimal fraction of bladder neoplasms and often pose diagnostic challenges due to nonspecific symptoms. Arising from chromaffin tissue within the bladder wall, they may present with hematuria, paroxysmal hypertension, headache, or palpitations, frequently leading to misdiagnosis as other bladder tumors. We report the case of a 72-year-old man with hypertension admitted for gross hematuria, headaches, and paroxysms. Imaging revealed a 5.4×4.3 cm hypervascular mass on the right posterolateral bladder wall, confirmed cystoscopically. Pathology from transurethral resection showed a muscle-invasive paraganglioma with characteristic immunohistochemistry. Biochemical testing demonstrated elevated catecholamine metabolites, and staging excluded metastasis. The patient underwent open cystoprostatectomy with Bricker-type ileal conduit; final pathology confirmed a large paraganglioma without adverse features. Postoperatively, he remains asymptomatic and normotensive without medication. This case highlights the need to consider bladder paraganglioma in patients with hematuria and hypertensive episodes. Accurate diagnosis relies on biochemical, imaging, and histopathologic correlation, and complete surgical excision remains the cornerstone of management through a multidisciplinary approach.