High-grade undifferentiated prostatic sarcoma with heterologous differentiation: A rare case report and literature review

Primary prostatic sarcomas are extremely rare, accounting for less than 0.1 % of prostatic malignancies. They arise from mesenchymal stromal cells and exhibit aggressive behavior. We report a 45-year-old man with progressive lower urinary tract symptoms, abdominal distension, and weight loss. Imaging revealed a large pelvic mass inseparable from the prostate. Exploratory laparotomy showed a >30 cm encapsulated tumor, completely excised with partial prostate. Histopathology confirmed a high-grade undifferentiated sarcoma with heterologous differentiation. At two-year follow-up, the patient remained disease-free. Complete surgical excision remains the cornerstone of management, while multimodal therapy may be considered for high-risk or recurrent cases.