Recurrent bladder paraganglioma with peritoneal dissemination: An unusual pattern of metastatic progression. Case report and literature review

We report the case of a 26-year-old man diagnosed with multifocal bladder paraganglioma, an exceptionally rare neuroendocrine tumor. The patient presented with hypertension and adrenergic symptoms triggered by micturition, associated with elevated metanephrines and multiple pelvic lesions. He underwent complete laparoscopic resection, including partial cystectomy, achieving initial biochemical remission. Early local recurrence and subsequent peritoneal carcinomatosis, an uncommon metastatic pattern, were observed, requiring systemic therapy. This case highlights the diagnostic challenges, potential for aggressive behavior, and limited therapeutic options in metastatic bladder paraganglioma, underscoring the need for high clinical suspicion, adequate preoperative management, and long-term follow-up.