Bowl of Grapes Sign | Radiology Signs

Answer:

Bowl of Grapes Sign represents a multilobulated soft-tissue mass with multiple fluid-fluid levels and cystic spaces separated by septa, most characteristically described in synovial sarcoma of the extremities, reflecting hemorrhage and cystic/necrotic degeneration within these aggressive soft tissue tumors. It is also occasionally reported in undifferentiated pleomorphic sarcoma.

Why is it called so?

The sign is named for its resemblance to a bowl of grapes, due to multiple rounded hyperintense cystic areas of varying fluid intensities with intervening hypointense septa on T2-weighted or fluid-sensitive MRI sequences.

Pathophysiology

Synovial sarcoma is a heterogeneous soft-tissue malignancy that typically arises near, but not within, the joints of adolescents and young adults. In larger lesions (usually >5 cm), tumor hemorrhage and cystic/necrotic degeneration create fluid-fluid levels within multicystic compartments; thin fibrous septa remain hypointense on T2, producing the clustered grape-like appearance amid hyperintense fluid collections. The presence of this appearance has been associated with a higher likelihood of metastatic disease.

Alternative names: Bowl of grapes appearance

Other associated named signs: Triple sign (intermixed areas of low, intermediate, and high T2 signal intensity from fibrous/calcified tissue, cellular tumor, and hemorrhage/necrosis respectively, also seen in synovial sarcoma)

References

1. Cho EB, Lee SK, Kim JY, Kim Y. Synovial Sarcoma in the Extremity: Diversity of Imaging Features for Diagnosis and Prognosis. Cancers (Basel). 2023.
2. Murphey MD, Gibson MS, Jennings BT, Crespo-Rodríguez AM, Fanburg-Smith J, Gajewski DA. Imaging of synovial sarcoma with radiologic-pathologic correlation. Radiographics. 2006.