The female genital tract has a complex embryologic origin, tying together elements of the paramesonephric ducts, coelomic epithelium, mesenchyme, and primordial germ cells in an equally intricate physiology, characterized by dramatic changes in function not only over a woman's full life cycle (menarche, pregnancy, and menopause), but with her rapid monthly rhythm of ovulation and menstruation. It should not be surprising that the pathology of this organ system is similarly complex. Tumors of the female pelvis are not only common, but exceedingly varied, including epithelial carcinomas, stromal tumors, sarcomas, and hybrids such as carcinosarcomas. Since these tumors may differ markedly as to FDG avidity, aggressiveness, and route of spread, facile generalizations should be avoided. PET/CT imaging needs to be rigorously correlated with all available clinical and histopathologic information, and with an intimate understanding of the biology of the type of tumor(s) under consideration. The astute PET/CT interpreter also needs to have a clear idea of the clinical purpose of the scan. Is it being performed for initial diagnosis and staging, for therapy planning, or for detection of recurrence? The utility and predictive value of PET may differ in each of these settings, as will be explained in more detail in the case discussions below.
The objectives of this chapter are to furnish the reader with a basic understanding of the range of tumor types affecting each organ, and of the established or emerging role of PET/CT within each clinical context, thus enabling him to derive the maximum amount of information from a given scan. It goes without saying that these principles are to be enlarged from the reader's own fund of experience and personal observation.