Have a personal or library account? Click to login
Bladder paraganglioma: CT and MR imaging characteristics in 16 patients Cover

Bladder paraganglioma: CT and MR imaging characteristics in 16 patients

Open Access
|Dec 2021

Figures & Tables

Figure 1

CT and MR images of a 61-year-old male patient with bladder paraganglioma. The tumour was located in the posterior bladder wall, oval, well-defined margin, protruding into the bladder cavity with broad-base attachment to the bladder wall (short arrow). The lesion showed slight hypodensity and obvious enhancement on axial pre- and post-contrast-enhanced CT images (A, B), homogenous slight hyperintensity on T2-weighted images (T2WI) (C), marked hyperintensity on diffusion-weighted images (DWI) (D), hypointensity on apparent diffusion coefficient (ADC) maps (mean ADC value, 0.870 × 10-3 mm2/s) (E), hyperintensity compared to the gluteus maximus on T1-weighted images (T1WI) (F) and “fast in and slow out” on dynamic contrast-enhanced MRI (G, H).
CT and MR images of a 61-year-old male patient with bladder paraganglioma. The tumour was located in the posterior bladder wall, oval, well-defined margin, protruding into the bladder cavity with broad-base attachment to the bladder wall (short arrow). The lesion showed slight hypodensity and obvious enhancement on axial pre- and post-contrast-enhanced CT images (A, B), homogenous slight hyperintensity on T2-weighted images (T2WI) (C), marked hyperintensity on diffusion-weighted images (DWI) (D), hypointensity on apparent diffusion coefficient (ADC) maps (mean ADC value, 0.870 × 10-3 mm2/s) (E), hyperintensity compared to the gluteus maximus on T1-weighted images (T1WI) (F) and “fast in and slow out” on dynamic contrast-enhanced MRI (G, H).

Figure 2

CT and MR images of a 47-year-old female with malignant bladder paraganglioma. The bladder tumour was located in the inferior bladder wall with an irregular shape and ill-defined margin, invading the adjacent tissues (short arrow). The tumour showed iso-density and moderate enhancement on sagittal pre- and post-contrast enhanced CT images (A, B), inhomogenous hyperintensity on sagittal T2-weighted images (T2WI) (C), hyperintensity on diffusion-weighted images (DWI) (D), hypointensity on apparent diffusion coefficient (ADC) maps (mean ADC value, 0.852 × 10-3 mm2/s) (E), inhomogenous slight hyperintensity compared to the gluteus maximus on T1-weighted images (T1WI) (long arrow) (F), heterogenous marked enhancement on arterial phase (G) and coronal contrast-enhanced images (arrowhead) (H). In addition, a uterine fibroid on the posterior wall of the uterus was also found (asterisk on sagittal T2WI).
CT and MR images of a 47-year-old female with malignant bladder paraganglioma. The bladder tumour was located in the inferior bladder wall with an irregular shape and ill-defined margin, invading the adjacent tissues (short arrow). The tumour showed iso-density and moderate enhancement on sagittal pre- and post-contrast enhanced CT images (A, B), inhomogenous hyperintensity on sagittal T2-weighted images (T2WI) (C), hyperintensity on diffusion-weighted images (DWI) (D), hypointensity on apparent diffusion coefficient (ADC) maps (mean ADC value, 0.852 × 10-3 mm2/s) (E), inhomogenous slight hyperintensity compared to the gluteus maximus on T1-weighted images (T1WI) (long arrow) (F), heterogenous marked enhancement on arterial phase (G) and coronal contrast-enhanced images (arrowhead) (H). In addition, a uterine fibroid on the posterior wall of the uterus was also found (asterisk on sagittal T2WI).

Figure 3

CT and MR images of a 25-year-old female with malignant bladder paraganglioma. The tumour was located in the left bladder wall with irregular shape, presenting heterogenous hypodensity (short arrow) and obvious enhancement on axial pre- and post-contrast enhanced CT images (A, B), heterogenous slight or marked hyperintensity on T2-weighted images (T2WI) (C), heterogenous hyperintensity on diffusion-weighted images (DWI) (long arrow) (D), hypointensity on apparent diffusion coefficient (ADC) maps (mean ADC value, 0.997×10-3 mm2/s) (E), slight hyperintensity compared to the gluteus maximus on T1WI (F) and early marked enhancement on arterial phase images (G). Coronal enhanced MRI showed the lesion encased the left iliac artery branch (arrowhead); a similar enhanced lesion was located next to the left iliac vessels (asterisk), suggesting multiple paraganglioma (H).
CT and MR images of a 25-year-old female with malignant bladder paraganglioma. The tumour was located in the left bladder wall with irregular shape, presenting heterogenous hypodensity (short arrow) and obvious enhancement on axial pre- and post-contrast enhanced CT images (A, B), heterogenous slight or marked hyperintensity on T2-weighted images (T2WI) (C), heterogenous hyperintensity on diffusion-weighted images (DWI) (long arrow) (D), hypointensity on apparent diffusion coefficient (ADC) maps (mean ADC value, 0.997×10-3 mm2/s) (E), slight hyperintensity compared to the gluteus maximus on T1WI (F) and early marked enhancement on arterial phase images (G). Coronal enhanced MRI showed the lesion encased the left iliac artery branch (arrowhead); a similar enhanced lesion was located next to the left iliac vessels (asterisk), suggesting multiple paraganglioma (H).

Figure 4

Enhancement trend charts of bladder paragangliomas on CT and MR images. (A) Broken line graph of enhancement trend on CT images; (B) Box plot of density distribution on pre- and post-contrast enhanced CT images (arterial phase); (C) Broken line graph of dynamic enhancement trend on MR images; (D) Box plot of signal distribution on unenhanced and dynamic contrast-enhanced MR images.
Enhancement trend charts of bladder paragangliomas on CT and MR images. (A) Broken line graph of enhancement trend on CT images; (B) Box plot of density distribution on pre- and post-contrast enhanced CT images (arterial phase); (C) Broken line graph of dynamic enhancement trend on MR images; (D) Box plot of signal distribution on unenhanced and dynamic contrast-enhanced MR images.

Figure 5

Microscopic examination of paraganglioma. (A) Polygonal or oval tumour cells were rich in basophil granular cytoplasm and arranged in a sheet or organoid arrangement. (Hema toxylin and eosin staining, × 400). (B) Immunohistochemical staining of tumours cells was positive for chromogranin A (CgA) (EnVision × 200).
Microscopic examination of paraganglioma. (A) Polygonal or oval tumour cells were rich in basophil granular cytoplasm and arranged in a sheet or organoid arrangement. (Hema toxylin and eosin staining, × 400). (B) Immunohistochemical staining of tumours cells was positive for chromogranin A (CgA) (EnVision × 200).

Location and morphological characteristics of bladder paraganglioma

CharacteristicsNumber (%) of patients
Mean maximum diameter of tumour (cm)*2. 6 ± 1.0
Location
Anterior wall3 (18.7)
Posterior wall4 (25.0)
Left wall1 (6.3)
Right wall3 (18.7)
Dome2 (12.5)
Bottom3 (18.8)
Spatial relationship with the bladder wall
Protruding into the bladder cavity11 (68.7)
Protruding into the pelvic cavity1 (6.3)
Protruding into the bladder and pelvic cavities4 (25.0)
Morphological characteristics
Oval10 (62.5)
Lobulated4 (25.0)
Fusiform2 (12.5)
Tumor margin
Well-defined14 (87.5)
Ill-defined2 (12.5)

Clinical characteristics of patients with bladder paraganglioma

CharacteristicsNumber (%) of patients
Median age in years (interquartile range)51 (40, 63)
Sex
Male7 (43.8)
Female9 (56.2)
Clinical manifestations
Postmicturition syndrome*6 (37.5)
Hypertension3 (18.8)
Hematuria or progressive dysuria3 (18.7)
24-h urinary VMA and CA level
Not measured11 (68.8)
Normal4 (25.0)
Elevated1 (6.2)
Tumor number
Single14 (87.5)
Multiple2 (12.5)
Surgical approach
Partial cystectomy7 (43.8)
Local resection of bladder tumor**9 (56.2)
Imaging methods
Computerized tomography13 (81.3)
Magnetic resonance imaging8 (50.0)

CT and MR image characteristics*

Computerized tomography (n = 13)
DensityModerate or slightly lower density
Enhancement characteristicsModerate to marked enhancement
CalcificationNone
Cystic degeneration or necrosisRare (n = 2)
HaemorrhageNone
Magnetic resonance imaging (n = 8)
T2-weighted imagingSlight hyperintensity
Diffusion-weighted imagingHyperintensity
Apparent diffusion coefficient (ADC) mapHypointensity (ADC value, 0.883±0.126×10-3 mm2/s)**
T1-weighted imagingSlight hyperintensity
Enhancement characteristics“Fast in and slow out” pattern
Cystic degeneration or necrosisRare (n = 2)
HaemorrhageNone
DOI: https://doi.org/10.2478/raon-2021-0055 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Language: English
Page range: 46 - 53
Submitted on: Aug 3, 2021
Accepted on: Nov 24, 2021
Published on: Dec 30, 2021
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2021 Jing Zhang, Xu Bai, Jing Yuan, Xiaojing Zhang, Wei Xu, Huiyi Ye, Haiyi Wang, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.