Utility of the broccoli sign in the distinction of prolapsed uterine tumor from cervical tumor

Objective: To describe the utility, histopathological basis, and clinical correlates of the broccoli sign. Methods: The committee on human research approved this HIPAA compliant study and waived written informed consent. Based on the records of the senior author and our multidisciplinary Gynecologic Oncology Tumor Board, we retrospectively identified thirteen women (mean age of 48.8 years; range, 34-74) with a cervical mass seen at MR imaging (n = 13) or CT (n = 5) that demonstrated the previously reported broccoli sign (i.e., a soft tissue stalk connecting the cervical mass to the uterine cavity) on one or other modality. All available clinical, imaging, and histopathological records were reviewed, with particular emphasis on initially suspected diagnosis, final proven diagnosis, and outcome. Results: Cervical cancer was the initial clinically suspected diagnosis in 6 of 13 patients. Surgical resection demonstrated prolapsed uterine tumor in all patients, consisting of endometrioid adenocarcinoma (n = 7), carcinosarcoma (n = 2), adenosarcoma (n = 1), and leiomyoma (n = 3). Excluding the three patients with leiomyomas, currently, 7 patients with malignant tumors are disease free after a mean interval of 15 months (range, 3-45) and 3 patients have been lost to follow-up. Conclusion: A stalk connecting an apparent cervical mass seen at CT or MR imaging to the endometrial cavity ("broccoli sign") favors the diagnosis of a prolapsed uterine tumor; these prolapsed uterine tumors can often be malignant but appear to have a good prognosis.