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目的:提高对膀胱副神经节瘤的诊断和治疗水平。方法:回顾性分析3例膀胱副神经节瘤患者的临床和病理资料:3例患者均有高血压病史,其中2例表现为排尿时阵发性高血压,1例表现为间歇性肉眼血尿。肿瘤直径1.5~3.0cm。2例行膀胱部分切除术,1例行TURBT术。结果:病理检查组织细胞多数为多边形,有的为梭形,富于嗜伊红细颗粒状胞浆,核分裂少见,间质富含毛细血管,个别细胞核有非典型性及多核瘤巨细胞。免疫组化染色CgA、NSE、Syn阳性,病理诊断为副神经节瘤。3例患者随访16~35个月,所有患者术后未见复发及转移,高血压治愈2例,明显改善1例。结论:膀胱副神经节瘤的典型表现为与排尿有关的阵发性头痛、头晕等高血压发作症状,少数可表现为肉眼血尿;应用B超、CT、膀胱镜可做定位诊断,尿VMA和儿茶酚胺可作定性诊断;由于可能诱发高血压危象,术前不主张活检。手术切除是首选治疗方法,术后应严密随访。
Objective: To improve the diagnosis and treatment of bladder paraganglioma. Methods: The clinical and pathological data of 3 patients with bladder paraganglioma were retrospectively analyzed. All 3 patients had a history of hypertension, 2 of whom showed paroxysmal hypertension during voiding and 1 case of intermittent gross hematuria. Tumor diameter 1.5 ~ 3.0cm. 2 cases of partial partial resection of the bladder, 1 case of TURBT surgery. Results: Most of the histopathological cells were polygonal, some were fusiform, rich in eosinophilic granular cytoplasm, mitotic rare, interstitial capillary-rich, individual nuclei have atypical and multinucleated giant cell. Immunohistochemical staining CgA, NSE, Syn positive pathological diagnosis of paraganglioma. Three patients were followed up for 16-35 months. No recurrence and metastasis were found in all patients. Two cases were cured by hypertension and one case was significantly improved. Conclusions: The typical manifestations of paraganghilic ganglioneuria include paroxysmal headache, dizziness and other symptoms of hypertension associated with micturition, a small number of which can be manifested as gross hematuria; diagnosis of urinary VMA and Catecholamines can be used for qualitative diagnosis; because it may induce hypertensive crisis, preoperative biopsy is not advocated. Surgical resection is the preferred treatment, should be followed up closely.