High-grade prostatic stromal sarcoma with a distinctive cystic-solid MRI pattern and aggressive clinical course: a case report

Objectives: To report a rare case of high-grade prostatic stromal sarcoma (PSS) and delineate its characteristic magnetic resonance imaging (MRI) features to facilitate early detection and accurate diagnosis. Methods: A 55-year-old male presented with progressive dysuria. Preoperative multiparametric pelvic MRI was performed. The imaging findings were correlated with histopathology from a robot-assisted laparoscopic radical prostatectomy. Results: MRI revealed a large, well-demarcated, encapsulated cystic-solid mass within the prostate. The solid components showed restricted diffusion. The cystic component contained multiple septations and demonstrated no diffusion restriction. An involvement nodule was identified in the right seminal vesicle. Histopathology confirmed high-grade prostatic stromal sarcoma with positive surgical margins. The patient experienced local recurrence within six months despite adjuvant chemotherapy. Conclusions: Prostatic stromal sarcoma is a rare malignancy with distinct MRI features that can help differentiate it from more common prostatic neoplasms.