Purpose: The study aims to assess the functional outcome of anal sphincter-sparing procedures (SSP) with total mesorectal excision (TME) for anorectal adenocarcinoma.Methods: In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME. Using the per anal examination scoring system (PASS), postoperative anal function was assessed after 1 year.Results: Bowel motility time was 50±19 hours. The time needed for narcotic analgesia was 54±18.8 hours. Mean hospital stay was 15.4±10.25 days. Incidence of evident fecal incontinence after ISR is 10.6% (7 of 67 cases). The PASS findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in 1 case (1.4%). Temporary diversion was performed in 61 patients (87.1%).Conclusion: Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides reasonable functional outcomes. PASS is a new application for postoperative assessment of anal function.

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Background: Colorectal carcinoma (CRC) is one of the serious causes of morbidity and mortality worldwide. It is characterized by activating mutations in genes encoding Receptor Tyrosine Kinases (RAS, RAF, MEK1 or MEK2) which act as driving oncogenes. DIAPH3 deficiency has been reported to enhance cancer cell motility, invasion and metastasis and also correlates with aggressive behaviour of cancer. Aim: To study the overexpression of MEK1 and DIAPH3 in CRC patients and their prognostic significance. Methods: We examined the immunohistochemical expression of MEK1 and DIAPH3 using tissue microarray technique in 150 CRC specimens divided into two groups. The mucinous group (MG) included specimens of 56 mucinous adenocarcinoma and 19 signet ring cell carcinoma, while the non-mucinous group (NMG) included 75 non-mucinous adenocarcinoma specimens for comparison. Results: MEK1 and DIAPH3 were strongly expressed in >50% of the studied specimens. The positivity of MEK1 expression was significantly higher in NMG compared to MG (66.7% and 34.3%, respectively; p<0.001). In all cases, the overexpression of MEK1 was significantly associated with peri-tumoral and intra-tumoral lymphocytic response (p=0.005 and 0.008, respectively). Furthermore, MEK1 overexpression showed statistically significant correlation with better OS (p=0.023) in the whole group of patients. The expression of DIAPH-3 did not differ significantly between NMG and MG (53.3% and 47.1%, respectively; p=0.456). There was strong relation between the overexpression of MEK1 and DIAPH3 (p<0.001). Conclusion:The results suggest a potential synergistic role of MEK1 and DIAPH3 overexpression and the development of CRC. Further large scale studies are warranted.

Purpose To evaluate tamoxifen-related endometrial changes in premenopausal female patients with diffusion-weighted magnetic resonance imaging (DWI). Methods This prospective study was performed on 71 premenopausal female patients (mean age, 41 years) who were receiving tamoxifen therapy. All patients underwent magnetic resonance imaging with DWI of the pelvis and hysteroscopic-guided endometrial biopsy. The apparent diffusion coefficient (ADC) values of the endometrial plate were calculated and correlated with pathological results. Results The mean ADCs of tamoxifen-related benign endometrial lesions (1.35 ± 0.19 and 1.32 ± 0.13 × 10−3 mm2/s) were significantly higher (P = 0.001) than those of normal endometrial plate (0.95 ± 0.11 and 0.93 ± 0.11 × 10−3 mm2/s) by both reviewers, respectively. The cutoff ADC values used to differentiate tamoxifen-related benign endometrial lesions from normal endometrium were 1.07 and 1.02 × 10−3 mm2/s with areas under the curve of 0.94 and 0.93 and accuracy of 94.4 and 95.8 by both reviewers, respectively. The mean ADC values of endometrial polyp (EP) (1.44 ± 0.19 and 1.42 ± 0.22 × 10−3 mm2/s) were significantly higher (P = 0.001) than those of endometrial hyperplasia (EH) (1.25 ± 0.19 and 1.23 ± 0.19 × 10−3 mm2/s) by both reviewers, respectively. The cutoff ADC values used to differentiate EP from EH were 1.38 × 10−3 and 1.36 × 10−3 mm2/s with areas under the curve of 0.81 and 0.77 and accuracy of 80% and 70% by both reviewers, respectively. There was an insignificant difference in ADC value between typical and atypical EH. The ADC values of endometrial cancer (0.80 and 0.78 × 10−3 mm2/s) were lower than those of tamoxifen-related benign endometrial lesions. The final diagnosis was normal endometrium (n = 36), benign endometrial lesions either EH (n = 17), or EP (n = 16), and endometrial cancer in only 2 patients. Conclusions We concluded that DWI helps in detection and characterization of different tamoxifen-related endometrial changes in the premenopausal female patients.