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Background
When female patients present with uterine masses that prolapse through the cervical os, radiologists often reflexively suggest leiomyomas and polyps as the etiology. Although these are the most common, there are multiple other masses, both benign and malignant, which may present as a prolapsing uterine mass. The purpose of this educational exhibit is to present a comprehensive differential diagnosis for protruding uterine masses using multiple modalities, drawing attention to features which may suggest a diagnosis other than leiomyoma or polyp.

Educational Goals / Teaching Points
After viewing this exhibit, the reader will be able to recognize the spectrum of pathology of prolapsing uterine masses, and understand the approach to evaluating a prolapsing uterine mass and recognize key imaging features that suggest alternative diagnoses other than leiomyomas or polyps.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Relevant uterine/vaginal anatomy: leiomyoma (degenerating leiomyoma, lipoleiomyoma), polyp (endometrial polyp, endocervical polyp), mixed Mullerian tumors [Biphasic] (carcinosarcoma, adenosarcoma, adenomyoma), endometrial carcinoma, sarcoma (leiomyosarcoma, endometrial stromal sarcoma, embryonal rhabdomyosarcoma), and miscellaneous (focal adenomyosis, uterine inversion).

Conclusion
Prolapsing uterine masses are often thought to be leiomyomas and polyps. However, since there are a wide spectrum of pathologies including benign and malignant etiologies that may present similarly, it is important for the radiologist to be aware of the imaging features that suggest an alternative diagnosis.