Composite paraganglioma-ganglioneuroma of the urinary bladder: a rare neoplasm causing hemodynamic crisis at tumour resection

A 64-year-old man presented with gross painless hematuria.Cystoscopy revealed a submucosal bladder neck mass coveredby normal urothelium. During transurethral resection, the patientdeveloped hemodynamic crisis including sinus bradycardia.Histopathologic examination revealed a primary bladder compositeparaganglioma-ganglioneuroma (CPG). The patient underwentpartial cystectomy and is symptom-free after one year. BladderCPGs are extremely rare neoplasms that may result in lifethreateningcatecholamine secretion, especially during tumourmanipulation. These tumours require complete surgical excisionand should be included in the differential diagnosis of any solitarybladder mass covered by normal urothelium, especially whenthere is a history of hypertension or micturition attacks.