Primary paraganglioma arises in frequently in the uri nary bladder. We present here the clinicopathologi cal, immunohistochemical and ultrastructural find ings in a 23-year-old Saudi female. She was hospi talised because of gross haematuria over the previ ous seven days. The intravenous urogram revealed a filling defect in the urinary bladder. Cystoscopy dis closed a non-papillary tumour arising from the roof of the bladder neck. Transurethral resection was, accordingly, performed - but marked fluctuation in blood pressure was observed during the procedure. The histopathological findings of trabeculae and small nests of plump oval to spindle cells with a clear to acidophilic cytoplasm, forming an organoid pat tern and demonstrating inconspicuous mitotic activ ity, were diagnostic of paraganglioma of the urinary bladder; the diagnosis was confirmed by means of immunohistochemical and ultrastructural studies. The endocrine markers chromogranin A and neu ron-specific enolase were positive in chief cells; sus tentacular cells at the periphery of neoplastic cell clusters were positive for S-100 protein. Neurosecre tory granules were identified by electron microscop ic examination. It is emphasised that, currently, there are no anatomico-pathological criteria to distinguish benign and malignant forms of the disease. Post-sur gical recovery was uneventful in this case. Recurrence and metastases, though infrequent, have been report ed in the literature; therefore, radiation therapy may be an important adjunct - and long-term follow-up is mandatory.
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