Background Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision.Methods TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8-10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743.

Heavy diffuse bleeding from congested gastric mucosa (congestive gastropathy) was treated by propranolol (dose = 24 to 480 mg per day) in 14 consecutive patients with portal hypertension. Thirteen patients (93%) stopped bleeding within 3 days. Gastric mucosal cherry red spots (a sign of severe gastropathy) were unchanged in 5 patients, became less obvious in 4 and appearances returned to normal in 5. Propranolol was discontinued electively in seven patients after 2 to 6 months; four of these patients rebled from the same lesion and stopped bleeding when propranolol was recommenced. No patient has rebled from congestive gastropathy while receiving propranolol during follow-up of 12 to 42 (median = 23) months. A further 24 patients with nonbleeding congestive gastropathy received 160 mg long-acting propranolol per day in a double-blind placebo controlled cross-over trial. Twenty-two patients completed the study; in nine patients, endoscopic grading of congestive gastropathy improved after propranolol compared to three after placebo (p less than 0.05). Although the mechanism of action is not understood, propranolol appears to have a clinically significant role in the management of nonvariceal gastric bleeding in portal hypertension.

Detection of BORIS in prostate tumors suggests potential applications of BORIS as a biomarker for prostate cancer diagnosis, as an immunotherapy target and, potentially, a prognostic marker of more aggressive prostate cancer. The ability of BORIS to activate the AR gene indicates BORIS involvement in the growth and development of prostate tumors.

SUMMARY Sixty slides from 60 blocks taken from 30 colonic carcinomas were circulated twice to six histopathologists of varying experience. Five of the six pathologists showed a good to excellent intraobserver agreement for assessment of the character of the invasive margin (0 44 < K < 082), which was not significantly affected by sampling (0 40 < K < 0 56, comparing both slides from each tumour) or observer (five of six pathologists agreeing on 46 of 60 slides). Pathologists were unreliable in assessing peritumoural lymphocytic infiltrates, with only two pathologists achieving moderate levels of intraobserver agreement (-0-03 < K < 0-52). The interobserver agreement for peritumoural lymphocytic infiltrates was also low (K < 0-29) between the three most experienced pathologists. The assessment of peritumoural lymphocytic infiltrates was significantly affected by sampling, the two pathologists with the lowest intraobserver variation achieving K values of 0-21 and 0 10 between the 30 paired slides from each tumour.The character of the invasive margin was reliably assessed, was not dependent on sample, and added useful prognostic information, but peritumoural lymphocytic infiltration is not a reproducible observation and may therefore not add useful prognostic information in routine use.

An 82-year-old female underwent anterior exenteration, ileal conduit formation and bilateral lymphadenectomy for definitive treatment of high-grade bladder transitional cell carcinoma (TCC) with muscle invasion (G3 pT2). On initial diagnosis, transurethral resection of bladder tumour (TURBT) and a cycle of mitomycin C were performed. Staging computed tomography (CT) confirmed the tumour was organ confined. The patient also had hypertension, chronic kidney disease stage 3 and a left pelvic kidney. She had an anterior resection performed for a colonic fistula secondary to diverticular disease.After surgery, she was sixteen followed up regularly in clinic with CT scans at nine, and twenty-four months. Ten months following her last scan, she attended clinic with a painful lymph node in the right groin. Biopsy revealed poorly differentiated carcinoma consistent with metastatic bladder TCC. CT scan showed enlarged right inguinal lymph nodes and less prominent left inguinal lymph nodes. Incidentally, in the same month, she had presented to her general practitioner experiencing offensive smelling, blood-stained vaginal discharge. Examination found a 1 cm ulcerated, cystic lesion on the anterior tip of the right labia majora. This prompted referral to the gynaecology team and a wedge biopsy was performed. Pathological analysis revealed intact, non-dysplastic squamous cell epithelium of vulval mucosa with an underlying nodule of poorly differentiated carcinoma (see Figures 1 and 2). The biopsy was consistent with a metastasis from TCC of the bladder. The margins were negative. Results prompted referral back to the urology team for wide local excision of the cyst.She became under joint urological and oncology care and was seen regularly in their clinic. Six months later, a small palpable, hard nodule adjacent to the patient's stoma was found. Biopsy consequently confirmed another metastatic TCC.She was referred to palliative care services and died four years following diagnosis. DiscussionThis is the first reported case of TCC metastasis to the labia majora in literature following a PubMed and OVID review back to 1955.Labia majora metastasis secondary to transitional cell cancer of the bladdera rare cutaneous manifestation of a common urological neoplasm