Paraganglioma of the urinary bladder is rarely encountered and its biological behavior is uncertain. It represents less than 1% of the bladder tumors and is usually benign. The tumor usually develops in young adult women. The most prevalent involved sites are discussed controversially in the literature.

Paragangliomas in the head and neck are found typically in the region of the carotid body, jugular body, and along the 9th and 10th cranial nerves. They can occur in multicenteric forms, but generally, laryngeal Paragangliomas are not found in these patients. Only two cases of laryngeal Paraganglioma have been reported with a synchronous lesion elsewhere. We report an additional case of a 34-year-old female with Multiple Paragangliomas beginning with laryngeal involvement.

Paragangliomas are neoplasms of neural crest origin. In the head and neck, they uncommonly involve the larynx. The distinction between Paragangliomas and other neuroendocrine tumors can be difficult. Precise diagnosis is important in order to optimize patient treatment. Diagnosis relies mostly on histopathologic examination followed by immunohistochemistry. Here we report a 77-year-old woman with laryngeal Paraganglioma that initially misdiagnosed as laryngeal carcinoid tumor.

A 41-year-old female complaining of an eight month history of dysphagia from 8 months ago presented to the Otolaryngology Department at Loghman Hakim Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. There was no history of any current infections of the upper respiratory tract, dental problems, and inflammations of the oral cavity, oropharynx, salivary glands, nose, or paranasal sinuses. There was no pain, malaise, fever, or weight loss.

Introduction: Carotid body tumor is a rare benign tumor originating from cells of neural crest tissue. It could present with Horner's syndrome. This tumor is rare and comprises 0.5% of all neoplasms. A familial incidence with autosomal dominant transmission has been reported. I have a series of five patients from a known family with one death during surgery because of carotid artery rupturing, others were diagnosed by color Doppler US and dynamic CT scan. Generally, it is sporadic and more frequently seen in high-altitude living people.Sex incidence is approximately equal, "little bit more frequent in the female".A characteristic saddle deformity is seen in invasive angiography.Symptoms are nonspecific; such as, headache, dizziness, tinnitus, loss of hearing acuity, hoarseness, vocal cord or hypoglossal nerve paralysis and syncope. Horner's syndrome is due to sympathetic chain involvement.Three stages or types of disease have been described by Shambling and colleagues First, minimally involved internal carotid artery "sub-adventitial"Second, partial incorporation of the sheath of internal carotid arteryThe third type is encircling of internal carotid artery with dense adherenceImaging: High frequency, high-resolution ultrasonography and color Doppler study are necessary to see blood flow in the artery, bifurcation widening and blood flow in the tumor (low resistance).Spiral dynamic X-ray CT: Spiral CT with MPR'S and 3D-angiography is the best imaging to show tumor vascularity and the internal carotid lumen.DSA or invasive angiography is used for preoperative embolization (larger than 2 cm) just before surgery (gold standard).MRI with dynamic and without GD and MRA could replace X-ray CT scan.Treatment is surgery, embolization and radiation therapy.Ninety-seven patients have been reported from Iran by Mohammad Taghi Salehian as an original article.Rare statements: A malignant unilateral chemodectoma may appear and metastasize to the bone in 6-12.5% of the cases. The abdominal wall is another rare location of metastasis.A sex-linked genetic trait is possible. All bilateral tumor cases are benign. 90% of tumors are unilateral and 10% are bilateral. Sporadic forms are more common than the inherited variety.65% of head and neck Paragangliomas are carotid body tumors.Classification is sporadic, familial and hyperplastic.The common age involvement is the fifth decade, but in MENS (Multiple endocrine neoplasia) syndrome, it develops in younger patients.Carotid body tumors have been reported in siblings of a Turkish family together with the involvement of adrenal pheochromocytomas.Differential Diagnosis: The main differential diagnoses are lymphadenopathy, bronchial cleft cyst, metastatic carcinoma, lymphoma, neurogenic tumors, salivary gland tumors, aneurysm, giant cell arteries, hematoma, carotid calcification or stone.

A 32-year-old woman was admitted because of severe uncontrolled hypertension associated with intermittent headache, diaphoresis, and blurred vision. She had a 3-year history of hypertension. Her symptoms were worsened by urination. Physical examination revealed a blood pressure of 155/120 mm Hg and bilateral papilledema. The tilt test was negative. Bruit over the renal artery was not audible. Laboratory examinations are shown in the Table. Abdominopelvic computed tomography showed lymphadenopathy in the celiac region and a 23-mm enhancing lesion in the bladder floor. No mass lesions were seen in the adrenal glands. Abdominopelvic magnetic resonance imaging confirmed computed tomography findings (Figure 1). Metaiodobenzylguanidine scan was negative. A 2. 5 × 2. 5 × 1-cm mass was completely removed laparoscopically. Pathologic report concluded urothelial mucosa with submucosal neoplasm composed of monomorphic polygonal cells with central round nuclei. Fine speckled chromatin and marked nucleoli as well as granular eosinophilic cytoplasm arranged as nest formation. No obvious mitotic figures were seen. Diagnosis of Paraganglioma was confirmed with chromogranin and synaptophysin immunohistochemical staining (Figure 2).