Figure 1. There is a heterogeneous, hypermetabolic (SUV_max 9.9) vaginal mass extending superiorly into the cervix. There is hydrometrocolpos, likely secondary to tumour obstruction. There is loss of the normal tissue planes in the Pouch of Douglas, suspicious for rectal invasion.

Hypodense, eumetabolic nodules are present in the uterine fundus, consistent with fibroids.

Figure 2. The vaginal lesion is again seen. There are bilateral hypermetabolic (SUV_max up to 1.8) parametrial lymph nodes, suspicious for locoregional nodal metastases. There is no evidence of distant nodal or organ metastasis.

Vaginal squamous cell carcinoma.

Primary vaginal carcinomas are extremely uncommon, comprising approximately 1% of female genital tract malignancies. The majority of these (approx 95%) are squamous cell carcinomas, and most are associated with human papilloma virus. The tumour usually arises from the upper 1/3 of the posterior vaginal wall. Secondary vaginal malignancies are commoner than primary vaginal malignancies.

Data on the use of FDG-PET and FDG-PET/CT in vaginal carcinoma is relatively sparse. FDG-PET however, has been shown to be more sensitive in the detection of primary vaginal carcinoma and metastatic lymphadenopathy than CT. FDG accumulation in a vaginal tampon is a recognized PET/CT artifact in the assessment of vaginal uptake.