# A high-grade undifferentiated prostate malignancy in a young male suggestive of male adnexal tumour of Wolffian origin – A rare case and diagnostic challenge

## TL;DR

A rare case of aggressive prostate cancer in a young man highlights the diagnostic challenges and the importance of early multidisciplinary treatment.

## Contribution

This case report presents a rare high-grade prostatic malignancy in a young male and highlights the diagnostic and therapeutic challenges associated with such rare tumors.

## Key findings

- Prostatic malignancies in young adults are extremely rare and often present diagnostic difficulties.
- Multidisciplinary approaches and aggressive treatment can lead to remission in rare, aggressive prostate tumors.
- Current diagnostic tools struggle to classify rare tumor subtypes like male adnexal tumors of Wolffian origin.

## Abstract

We report a rare case of a high-grade, poorly differentiated prostatic malignancy in a 24-year-old, initially presenting with haematuria and urinary retention following trauma. Imaging and cystoscopy revealed a large prostate mass. Although a final histopathological diagnosis could not be definitively determined, expert review suggests this may resemble a male adnexal tumour of Wolffian origin, an extremely rare pathology. The patient underwent neoadjuvant chemotherapy, followed by radical cystoprostatectomy and adjuvant radiotherapy. He remains in remission 18 months post-treatment. This case underscores the importance of thorough investigation and multidisciplinary management of rare, aggressive prostatic tumours in young patients.

•Rare presentation – Prostatic malignancies in young adults are exceptionally uncommon. This case emphasizes the need to consider malignant pathology even in patients outside the typical demographic.•Diagnostic challenges – Despite advanced imaging, immunohistochemistry, genetic testing, and expert histopathology review, a definitive tumour subtype was difficult to establish. This underlines the limitations of current diagnostic tools in rare tumour biology.•Importance of early, multidisciplinary intervention – Prompt recognition of haematuria as a red-flag symptom, coupled with imaging, enabled early diagnosis. Aggressive multimodal therapy within a multidisciplinary framework resulted in 12-month remission.

Rare presentation – Prostatic malignancies in young adults are exceptionally uncommon. This case emphasizes the need to consider malignant pathology even in patients outside the typical demographic.

Diagnostic challenges – Despite advanced imaging, immunohistochemistry, genetic testing, and expert histopathology review, a definitive tumour subtype was difficult to establish. This underlines the limitations of current diagnostic tools in rare tumour biology.

Importance of early, multidisciplinary intervention – Prompt recognition of haematuria as a red-flag symptom, coupled with imaging, enabled early diagnosis. Aggressive multimodal therapy within a multidisciplinary framework resulted in 12-month remission.