Bladder Pheochromocytoma
Introduction
Introduction to bladder pheochromocytoma The pheochromocytomaofbladder is a non-epithelial tumor of the bladder that originates from chromaffin cells left in the bladder wall during the embryonic period. The tumor originates from the parasympathetic ganglia of the bladder wall. About 83% of the bladder pheochromocytoma can produce hormones, which are secreted when the bladder is detrusor contracted because the tumor is squeezed. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: Hypertensive crisis Retinal detachment
Cause
Cause of bladder pheochromocytoma
(1) Causes of the disease
The etiology of pheochromocytoma is as unclear as other tumors, but there are several special cases that may be related to the etiology of pheochromocytoma. Early embryonic sympathetic neurons originate from neural crests and neural tubes, are sympathetic mother cells and A common precursor of chromoblasts, most of the chromoblasts migrate into the embryonic adrenal cortex to form the embryonic adrenal medulla, and another part of the chromoblasts migrates to the paravertebral or aortic sympathetic ganglia with the sympathetic neuroblasts. Forming extra-adrenal pheochromocytic cells, the extra-adrenal pheochromocytic cells mature at 9 to 11 weeks after embryos, and mature earlier than the adrenal medulla chromaffin cells. After birth, the adrenal medulla chromaffin cells mature and the extra-adrenal glands The chromaffin cells degenerate and gradually disappear, so in the embryonic period, multiple chromaffin cells are distributed. Only the adrenal medulla cells can remain in the mature stage. Under certain special circumstances, these homologous neuroectodermal cells can occur. Corresponding tumors.
(two) pathogenesis
Bladder pheochromocytoma is mostly confined to the bladder wall or only to the wall. The identification of benign and malignant does not depend on biological indicators or cytological features, but the tumor should be infiltrated into the capsule or adjacent tissue. Or non-chromophobic tissue outside the bladder has metastases as a basis for the diagnosis of malignant pheochromocytoma.
The cause of pheochromocytoma of the bladder may be related to the residual chromatin tissue in the bladder. The tumor is nodular or polypoid, and the texture is hard. It has obvious boundaries with normal bladder tissue, but most of the adjacent bladder muscle layer is destroyed. The mucosa may have ulcers, the tumor section is homogeneous, brown or yellowish brown, the tumor cells are polygonal or fusiform, and there are many cytoplasmic granules, which are easily stained by chromium salts. The cell population is lobular, strip-shaped or small nest-like.
Prevention
Bladder pheochromocytoma prevention
There is no preventive method for this disease. Early detection, early diagnosis and early treatment are of great significance for the indirect prevention of this disease.
Complication
Bladder pheochromocytoma complications Complications, hypertensive crisis, retinal detachment
1. Hypertensive crisis: It is an extremely critical symptom complicated by hypertensive patients. Under the influence of adverse causes, blood pressure suddenly rises above 26.6/16 kPa (200/120 mm Hg), and heart and brain appear. Acute damage to the kidneys.
2. Hypertensive retinopathy: refers to the continuous increase of systemic arterial blood pressure, causing blood-retinal barrier destruction, plasma leakage, formation of blood vessels in the blood vessels, retinal edema, hemorrhage, ischemia or exudation. In the case of severe disease, retinal detachment may occur.
Symptom
Symptoms of pheochromocytoma of the bladder Common symptoms Hypertension, pale, diabetic, hematuria
The typical clinical manifestations of pheochromocytoma of the bladder are hypertension, hematuria and diabetes. Hypertension can be persistent or paroxysmal. It is characterized by paroxysmal hypertension when the bladder is full, pulse is accelerated, pale, headache, and out Sweat, etc., the symptoms reached peak during urination, syncope may occur, symptoms gradually relieved after urination, hematuria is mostly painless, intermittent gross hematuria, bladder pheochromocytoma without endocrine function may have no symptoms except local lesions.
Examine
Examination of bladder pheochromocytoma
Determination of urinary catecholamine (CA) and its metabolite (3-methoxy-4-hydroxymandelic acid VMA) is helpful for qualitative diagnosis, but the non-seizure positive rate is low, and the phentolamine inhibition test is positive. Important diagnostic basis.
1. B-ultrasound, CT or MRI can determine the tumor size and whether there is metastasis, CT is a practical and valuable imaging method for the location diagnosis of ectopic pheochromocytoma.
2. The positive rate of cystoscopy is about 80%. It can be seen that the local bladder mucosa protrudes into the cavity. It has a hemispherical basal surface, smooth surface and congested redness. Because pheochromocytoma is located in the bladder wall, it is only a positive rate of mucosal biopsy. Low and easy to bleed.
3.131I-MIBG (131I-meta-iodobenzidine) imaging can be specifically localized, the higher the activity of pheochromocytoma, the more concentrated 131I-MIBG, the higher sensitivity of 131I-MIBG in the diagnosis of bladder pheochromocytoma For B-ultrasound, CT has been widely used.
Diagnosis
Diagnosis and differentiation of pheochromocytoma of bladder
Bladder pheochromocytoma is easier to diagnose. In addition to the typical symptoms, cystoscopy is the basis for localization diagnosis. When checking, blood pressure may rise, and precautions should be taken in advance.
Bladder epithelial tumors: hematuria is obvious, generally diffuse infiltration into the cavity or the diffuse infiltration of the bladder wall, biopsy can confirm the diagnosis.
