Primary female urethral carcinoma with bladder neck invasion: multiparametric MRI features and staging implications

Primary female urethral carcinoma is an exceptionally rare and frequently underrecognized malignancy, accounting for less than 1% of genitourinary cancers. Clinical presentation is often nonspecific, resulting in delayed diagnosis and advanced local disease at the time of imaging evaluation. Magnetic resonance imaging (MRI) represents the imaging modality of choice for local staging because of its superior soft-tissue characterization, multiplanar capability, and ability to assess periurethral extension. We report the case of a 68-year-old woman presenting with progressive dysuria, recurrent urinary tract infections, urinary obstruction, and intermittent hematuria. Multiparametric pelvic MRI demonstrated an irregular infiltrative soft-tissue mass centered on the proximal urethra, characterized by intermediate-to-high T2 signal intensity, marked diffusion restriction, and avid heterogeneous post-contrast enhancement. The lesion extended superiorly toward the bladder neck with infiltration of adjacent periurethral tissues and suspected involvement of the anterior vaginal wall. Histopathological analysis confirmed high-grade urothelial carcinoma of the urethra. This case illustrates the pivotal role of MRI in defining tumor origin, local extension, and adjacent organ invasion in female urethral carcinoma, while also emphasizing the importance of differentiating malignant periurethral lesions from benign mimickers. Awareness of characteristic MRI findings may improve diagnostic confidence and facilitate appropriate multidisciplinary management in this uncommon but aggressive neoplasm.