Paraganglioma of the urinary bladder
Description
• Pub is defined as an extra-adrenal sympathetic paraganglioma that develops from the bladder wall's chromaffin tissue.
• The study of epidemiology:
• uncommon tumor
• Age range: 11–84 years; mean age: 43
• Equitable distribution of sexes
• Average diameter: 3.9 cm; big tumors larger than 8 cm are rare.
• About 83% of hormones are produced by catecholamines.
• Typical signs and symptoms:
• High blood pressure (54.7%)
• Headache (48.1%)
• Hematuria (47.2%).
• Syncope and palpitations (43.4%)
• About 52.8% experienced "micturition attacks," which are symptoms that occur during urinating.
• This case: Asymptomatic because the arrhythmia and hypertension have been managed for a long time.
◉ Case Overview
• 64-year-old male patient
• History: Diabetes, tachyarrhythmia, and hypertension (well managed with medication)
• Finding: A sizable bladder tumor that was unintentionally discovered when evaluating for weight loss
• Vitals: blood pressure of 121/67 mm Hg
• Features of a tumor:
• Size: 8.5 cm for the resected specimen, 77 mm on CT
• Location: Bladder's posterior wall, ambiguous rectum border
• maging: hypermetabolic on PET-CT, heterogeneous enhancement (CT/MRI)
• External compression of the bladder trigone during a cystoscopy; no intraluminal bulk
• Rectal wall compression during colonoscopy; no rectal tumor
◉ Diagnostic Procedure
• EUS-FNA biopsy:
• Cells with a spindle form in fibrous tissue
• Immunohistochemistry: c-kit, S-100, β-catenin, and desmin were negative; CD34 was positive, indicating a mesenchymal tumor (possibly GIST).
• Pelvic neoplasm of unknown origin (suspected rectal GIST) was the preoperative diagnosis.
◉ Diagnostic Procedure:
• EUS-FNA biopsy:
• Cells with a spindle form in fibrous tissue
• Immunohistochemistry: c-kit, S-100, β-catenin, and desmin were negative; CD34 was positive, indicating a mesenchymal tumor (possibly GIST).
• Pelvic neoplasm of unknown origin (suspected rectal GIST) was the preoperative diagnosis.
◉ Pathological Results:
• Gross specimen: solid, yellowish-brown bulk, 85 x 60 × 45 mm
• Origin: Muscular and subserosal invasion of the bladder wall
• Absence of rectal invasion
• Microscopy: Tumor cell nests and cords (zellballen pattern)
• The study of immunohistochemistry
• Positive: Synaptophysin, CD56, and chromogranin A
• Cytokeratins AE1/AE3, CAM5.2, and SSTR2 are negative.
• Diagnosis: Urinary Bladder Paraganglioma (Pub)
Protocol
◉ Surgical Findings & Management:
• Procedure: En bloc multivisceral resection (low anterior rectum resection plus complete cystectomy)
• Intraoperative event:
• Perdipine controlled the marked hypertensive crisis (BP 190 mm Hg) following tumor manipulation.
• Following tumor excision, hypotension necessitates catecholamine support.
• Course after surgery: uneventful
◉ NURSING MANAGEMENT:
• Common Problems Faced
• The following problems are frequently encountered by patients receiving treatment for rare tumors or cancer:
• Acute and persistent pain
• Infection risk (procedural or postoperative)
• Errors in medication or adverse drug events
• Poor follow-up and therapy adherence
• Complications of treatment (nausea, vomiting, neuropathy)
• Lack of comprehension and emotional anguish
• Self-management and functional recovery challenges
• increased fall risk, particularly for elderly patients.
◉ Nursing and Management Interventions
• Pain management issues include both chronic tumor-related pain and acute post-operative pain.
• Nursing interventions include routine pain evaluation, the use of patient-controlled analgesia for severe cases, and the • provision of analgesics (both pharmaceutical and non-pharmacologic, such as music therapy).
• High risk of postoperative infections, particularly nosocomial and surgical site infections, is the infection control issue.
• Nursing Intervention: Using personal protective equipment, cleaning the surroundings, practicing strict hand hygiene, and implementing isolation procedures where needed
◉ Management of Medication:
• The issue is the possibility of adverse drug events and mistakes in the administration of medications.
• Nursing interventions include medication reconciliation, thorough drug regimen evaluations, and patient education regarding proper usage and possible adverse effects.
◉ Proactive and Preventive Care:
• Issue: Side effects of treatment, such as nausea, vomiting, and neuropathy, including those associated with cancer chemotherapy.
• Nursing intervention includes early dietary advice, appropriate antiemetic procedures, prompt monitoring, instruction on identifying and managing symptoms, and coordination for dosage modifications.
• Patient Education & Self-Management Problem: Poor adherence to treatments and lack of disease understanding.
◉ Nursing Intervention:
• Personalized patient education; counseling and frequent follow-up to encourage self-care abilities; and the use of technology (tele-nursing) for continuous evaluation and direction.
• Emotional and Psychosocial Assistance
• Problem:
• Psychological strain, worry, and emotional suffering brought on by the diagnosis and course of treatment.
• Nursing intervention includes support groups, counseling, active listening, and, if necessary, referrals to mental health specialists.
Notes
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