Bladder paraganglioma after kidney transplantation:A case report

BACKGROUND Kidney transplantation is associated with an increased risk of tumors in the urinary bladder.Among all the pathological types of tumors in the bladder,paraganglioma,which arises from extra-adrenal paraganglia and consists of chromaffin cells,is rare.Paragangliomas might cause severe clinical symptoms due to catecholamine hypersecretion or mass compression.Bladder paragangliomas are rare,especially those appearing after kidney transplantation.Here,we report a case of bladder paraganglioma developing after kidney transplantation.CASE SUMMARY A 63-year-old woman received a kidney transplant 12 years ago and took oral immunosuppressants(cyclosporine,mizoribine,and methylprednisolone)for regular post-transplant treatment.The patient felt no discomfort and she came to the hospital for a routine checkup.A mass located in the bladder was incidentally discovered by computed tomography,and she underwent surgical treatment.A 2 cm×2 cm invasive mass was found in the trigone of the bladder and the mass was removed.The diagnosis of paraganglioma was confirmed by morphology and immunophenotyping.The patient had a good prognosis and is still alive.CONCLUSION Paraganglioma can grow in the bladder,which might cause no clinical symptoms.The diagnosis mainly depends on morphology and immunophenotyping.Surgical resection is an important treatment option for such patients.

Aberrant expression of growth factor Wnt-5A in six urinary malignant cell lines

Objective To investigate the expression of growth factor Wnt 5A in urinary tumor cell lines. Methods By semi quantitative RT PCR (reverse transcriptase polymerase chain reaction), the expression of Wnt 5A in six urinary malignant cell lines, one primary cultured renal fibroblast and one case of normal human renal tissue was detected using Gel Doc 1000 computer controlled molecular analysis system. Results The expression of Wnt 5A in urinary tumor cell lines was much higher than that in primary cultured renal fibroblasts (PRF) and normal human renal tissue (NRT). The levels of Wnt 5A mRNA were different between six malignant cell lines. Conclusion The overexpression of growth factor Wnt 5A has a potential effect on the oncogenesis of urinary malignancies.

Orthotopic ileal neobladder similar to original bladder

Objective To report the surgical techniques and results of an 8-year follow-up study of 42 patients with a modified orthotopic ileal neobladder restoring normal anatomical relationship. Methods Total cystoprostatectomy was performed extraperitoneally. A 45-50 cm segment of the ileal loop was isolated, detubularized, and reconfigured into an “M”-shape to form a pouch. Bilateral ureters were implanted by inserting 1 cm distal segment into the pouch. The bottom of pouch was opened and anastomosed with the urethra. Results Forty-two patients were followed up for 6 to 96 months,90.5% of whom were continent in the daytime, and 85.7% at night. Two patients had a difficulty in urination. The average volume of the pouch was (361±48) ml at 12 months postoperation. Urodynamic examination showed the average peak voiding pressure was (86.8±21.4) cmH 2O. The average maximum flow rate (Qmax) was (18.4±6.1) ml/s. No remarkable ureter reflux and obstruction were found. No patient was detected to have urethral carcinoma.Conclusions Extraperitoneal cystectomy can avoid the tumor contamination of the abdomen and intestinal interference of the operative field. The ureter-inserting implantation technique is a simple anti-reflux anastomosis method with less ureter stenosis rate. Isolating the neobladder and ureters from the peritoneal cavity can reduce the postoperative complications, such as adhesive ileus, internal hernia, and urine leakage into the peritoneal cavity. The neobladder is similar to the original bladder in position, volume, shape and anti-reflux ureter connection.