Concomitant primary ovarian paraganglioma neuroendocrinal differentiated urothelial tumor in a BOTOX-injected bladder: A case report.

INTRODUCTION

There is no reported data for patients with malignant bladder Botox® injection related outcomes. Herein, we reported effect of Botox® injection in case of BCG cystitis. In addition, reporting of rare incidence of both primary neuroendocrine differentiation of bladder tumor and primary ovarian paraganglioma post cystectomy.

PRESENTATION OF CASE: A-64 years old female presented with sever irritative lower urinary tract symptoms (LUTS) post vesical BCG installation for carcinoma in situ. Patient's symptoms were relieved after Botox® bladder injection after anticholinergics failure. One year later, she came back with hematuria. Cystoscopy showed nodular bladder lesion. Hypertension episodes were noticed during cystoscopic resection. Pathological examination showed presence of muscle invasive transitional cell carcinoma (TCC) with neuroendocrine differentiation. Patient underwent radical cystectomy and pathology was associated with incidentally discovered primary ovarian paraganglioma.

DISCUSSION: Intravesical BCG is a standard adjuvant treatment for carcinoma in situ with 75% induced cystitis as a local side effect. The International Bladder Cancer Group's recommendation for BCG cystitis included many agents, these treatment options had very limited outcomes. The existence of paraganglioma in the female genital tract described rarely <1% in the vagina, uterus, vulva and ovary with only few reports. The same as paraganglioma small cell differentiation of vesical urothelial tumor is a rare entity with no reported cases of simultaneous occurrence and to differentiate each other as primary or metastatic.

CONCLUSION

Bladder Botox® injection could be offered as a treatment for overactive bladder-like symptoms in malignant cystitis. Neuroendocrine tumors are with a rare entity could be happened instantaneously in urogenital tract.