Case Author(s): Stephen Schmitter, M.D. and Farrokh Dehdashti, M.D. , 1/29/01 . Rating: #D3, #Q3

Diagnosis: Vaginal Condylomata

Brief history:

54 year-old woman with newly diagnosed cervical cancer.

Images:

Coronal FDG-PET Images

View main image(pt) in a separate image viewer

View second image(pt). Coronal, Axial, and Sagittal FDG-PET Images Through the Area of Interest

View third image(ct). Selected Axial CT Images

Full history/Diagnosis is available below

Diagnosis: Vaginal Condylomata

Full history:

54 year-old woman with newly diagnosed cervical cancer. FDG-PET imaging is performed for staging evaluation.

Radiopharmaceutical:

14.9 mCi F-18 Fluorodeoxyglucose i.v.

Findings:

Marked hypermetabolism is noted in the region of the cervix, consistent with the patient's known cervical cancer. Hypermetabolism is also present at the lower aspect of the vagina (main and second images).

Selected CT images (third image) demonstrate a low attenuation mass in the region of the cervix, consistent with cervical cancer. Ill-defined soft tissue fullness is present in the region of the lower vagina.

On physical examination, the patient was noted to have extensive, large condylomata acuminata (not shown) in the lower third of the vagina, corresponding to the region of abnormal uptake on FDG-PET.

Discussion:

Condylomata acuminata (genital warts) is a very common sexually transmitted disease. Approximately 1% of the sexually active population in the United States have clinically apparent genital warts. Approximately 10-20% of men and women 15-49 years of age have molecular evidence of genital human papilloma virus (HPV) infection. HPV is the agent responsible for the development of genital warts, and is an etiologic agent in the development of cervical cancer. The role of HPV in both of these conditions is further supported by the coexistence of cervical cancer and condylomata accuminata in this patient.

FDG-PET has been shown to be useful in the evaluation and staging of cervical cancer, due to the high avidity of cervical cancer for FDG. One study demonstrated uptake in 91% of primary tumors and a sensitivity and specificity for detection of para-aortic nodal metastases of 75% and 92%, respectively. Grigsby et al. have demonstrated that FDG-PET is superior to CT in detection of lymph node metastasis.

FDG uptake can be seen in a number of benign conditions, as well. Increased uptake has been reported in colonic, adrenal and thyroid adenomas, Warthin's tumor, and a number of inflammatory conditions. Given their rapid growth rate, it is not surprising that condylomata acuminata demonstrated increased FDG uptake in this patient.

Other potential causes of this pattern of uptake include extension of tumor, reflux of urine into the vagina (this patient had a foley catheter in place) or inflammation.

References:

Koutsky, L. Epidemiology of Human Papillomavirus Infection. Am J Med. 1997;102(5A):3-8

Rose et al. Positron emission tomography for evaluating para-aortic nodal metastasis in locally advanced cervical cancer before surgical staging: a surgicopathologic study. J Clin Onc. 1999;17(1):41-45

Yasuda S, Ide M, Shohtsu A. Cancer Screening with Whole-Body FDG PET. In: Ruhlmann J, Oehr P, Biersack HJ, eds. PET in Oncology. Berlin:Springer-Verlag, 1999:179-188.

Grigsby et al. PET evaluation of carcinoma of cervix. Clin Pos Img 1999; 2:1050109.

Followup:

The patient underwent radiation and chemotherapy and was re-imaged 3 months after the completion of therapy. FDG-PET images demonstrate marked interval decrease in uptake in the cervix, with persistent uptake in the region of the patient's vaginal condylomata.

View followup image(pt). Coronal, Axial, and Sagittal FDG-PET Images Through the Area of Interest

ACR Codes and Keywords:

References and General Discussion of PET Tumor Imaging Studies (Anatomic field:Genitourinary System, Category:Inflammation,Infection)

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Case number: pt047

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