Bladder paraganglioma presenting with atypical abdominal pain: A diagnostic challenge

Abstract

A 70-year-old man presented with a 10-day history of intermittent abdominal pain. Initial evaluation revealed a bladder nodule on imaging, but cystoscopy showed no tumor. Subsequent investigations including elevated urinary normetanephrine levels and MRI identified a hypervascular bladder mass supplied by the right internal iliac artery. Laparoscopic partial cystectomy confirmed a paraganglioma with positive immunohistochemistry (synaptophysin+, chromogranin A+). Postoperatively, symptoms resolved, and antihypertensive therapy was discontinued. This case highlights the importance of considering catecholamine-secreting tumors in patients with unexplained abdominal pain and hypertension, even without classic symptoms.