The impact of air pockets around the vaginal cylinder on vaginal vault brachytherapy.

OBJECTIVE: To evaluate the incidence, size and predisposing factors for air pockets around the vaginal cylinder and their dosimetric effect on the vaginal mucosa. METHODS: We investigated 174 patients with endometrial carcinoma treated with external radiotherapy (RT) and brachytherapy (BRT) (101 patients, 58%) or BRT alone (73 patients, 42%). The quantity, volume and dosimetric impact of the air pockets surrounding the vaginal cylinder were quantified. The proportions of patients with or without air pockets during application were stratified according to menopausal status, treatment modality and interval between surgery and RT. RESULTS: Air pockets around the vaginal cylinder were seen in 75 patients (43%), while 99 patients (57%) had no air pockets. Only 11 patients (6.3%) received less than the prescribed dose (average 93.9% of prescribed dose; range, 79.0-99.2%). Air pockets were significantly fewer in pre-menopausal patients or in patients treated with the combination of external RT and BRT than in post-menopausal patients or patients treated with BRT alone. A significant correlation existed between the mucosal displacement of the air gap and the ratio of the measured dose at the surface of the air gap and prescribed dose (Pearson r = -0.775; p < 0.001). CONCLUSION: Air pockets were still a frequent problem during vaginal vault BRT, especially in post-menopausal patients or in patients treated with BRT alone, which may potentially cause dose reductions at the vaginal mucosa. ADVANCES IN KNOWLEDGE: Air pockets around the vaginal cylinder remain a significant problem, which may potentially cause dose reduction in the target volume.

Idiopathic scrotal calcinosis: the incorrect terminology of scrotal calcinosis.

AIM: Scrotal calcinosis is a rare and benign condition characterized by multiple calcific deposits occurring in scrotum and formed as nodules and lumps within scrotal skin with any systemic metabolic disorder. The so-called idiopathic scrotal calcinosis does not appear to be idiopathic, but rather a process of dystrophic calcification of epidermal cysts. Histological examination shows calcium deposites with in the dermis that may be surrounded with histiocytes and an inflammatory giant cell reaction. The aim of this paper was to detect dystrophic calcification of epidermal cysts and to take attention to the incorrect terminology of "idiopathic calsification". METHODS: This is a two-centered study of scrotal calcinosis with 17 cases, on which clinical and histopathological examinations were conducted. RESULTS: The patients we examined all had scrotal epidermoid cysts in varying stages of inflammation coexisted with scrotal calcinosis. Some cyts (52.9%) had intact epithelial walls, others (35.2%) showed rupture of their epithelial walls associated with the presence of keratin fibers and calcium granules in the surrounding dermis and all had naked calcium deposits lying in the dermis. CONCLUSION: The spectrum of the changes that we experienced in the histology, coupled with the normal values in the biochemical profile, shore up the theory of dystrophic calcification of epithelial cysts. During the time first these cysts become inflamed than rupture in the and calcium depocytes replase with the cysts.