Imaging description

Prolapsed uterine tumors can extend inferiorly through the cervical canal, and then the cervical component of these tumors can falsely suggest a primary cervical malignancy at imaging (Figures 81.1–81.6) [1–3]. Generally, close inspection of the images will demonstrate stalk-like continuity with intracavitary tumor within the uterine body – this morphological clue has been called the “broccoli sign” [4].

Importance

Prolapsed uterine tumors may be benign or malignant, and misdiagnosis as a primary cervical cancer might result in inappropriate management.

Typical clinical scenario

Vaginal bleeding is probably the commonest symptom associated with prolapsed uterine tumors. The diagnosis is not always clear-cut at vaginal examination, and imaging may be critical in establishing the true origin of an apparent cervical mass. In a recent study of 1785 women undergoing abdominal surgery for uterine leiomyomas, the prevalence of prolapsing submucosal leiomyomas was 2.5% [5].

Differential diagnosis

Several uterine tumors may be intracavitary and prolapse into the cervix, including leiomyoma, adenomyoma, adenosarcoma, and endometrial carcinoma [1–4]. The distinction of these different pathologies will generally require tissue sampling, but the low T2 signal intensity and wellcircumscribed margin of prolapsing leiomyoma should allow differentiation of this entity from other possibilities [3].