Colonic Adenocarcinoma Presenting with Vaginal Bleeding

Abstract

Carcinoma of the vagina is a rare clinical problem and most commonly it is of the squamous cell type.Vaginal adenocarcinoma is even less common and often it is a secondary tumour from primary cervical or uterine corpus neoplasms. In the case reported post-hysterectomy vaginal bleeding occurred from a nodule which on biopsy revealed adenocarcinoma and it was the presenting symptom of an otherwise asymptomatic colonic tumour, a hitherto unreported presentation of a colonic carcinoma. CASE REPORTA 56-year-old Chinese woman presented on May 22, 1986 with a S-day history of intennittent vaginal bleeding. There were no symptoms referable to the urinary or gastrointestinal tracts. Seven years earlier in 1979, she had twice undergone uterine curettage for menorrhagia, and cystic endometrial hyperplasia had been diagnosed. She failed to respond to hormonal therapy and a year later in 1980, a total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed; histopathological examination of the specimens revealed hyperplasia of the uterine muscle but no cervical, endometrial or ovarian neoplasia. At the most recent presentation, general examination of the breasts, thyroid and other systems was entirely normal; vaginal examination revealed a reddened area with thickening and slight induration at the vaginal apex but no obvious tumour. The thickened area measured approximately 1 cm in diameter and appeared to be confined to the vaginal mucosa without any extension to the subvaginal tissues or the rectovaginal septum on rectovaginal examination. Contact bleeding was noted when the area was scraped for a cytology smear, which was reported to show severe dysplasia. At colposcopy the reddened area showed marked acetowhite change on application of 3% acetic acid, a rough surface contour and prominent atypical vessels enabling a colposcopic diagnosis of an invasive carcinoma to be made. Directed biopsies were obtained and these were reported to show an invasive moderately differentiated adenocarcinoma. Pathological review of the previous 1. Senior Lecturer and Consultant, Department of Obstetrics 2. Senior Lecturer, Department of Pathology. 3. Senior Lecturer, Department of Surgery. 4. Professor and Head, Department of Obstetrics and Gy-and Gynaecology. naecology.surgical specimens, which included examining further sections of the cervix, revealed no evidence of primary endocervical, endometrial or ovarian malignancy.In view of the histological findings, a chest radiograph, intravenous urogram and a computerized tomographic (CAT) scan of the abdomen and pelvis were obtained, which were all reported to be normal.Prior to therapy, an examination under anaesthesia confirmed the previous pelvic findings and a cystoscopic examination was normal; however a sigmoidoscopic examination revealed an ulcerated nodular growth 22 cm from the a n d verge. Biopsies of the growth showed colonic mucosa with areas of malignant transition to moderately differentiated adenocarcinoma with infiltrative tumour nests in the colonic submucosa....

Labelling of Histone H5 and Its Interaction with DNA. 2. Cooperative Binding of Histone H5 to DNA as Probed By Steady-State Fluorescence and Diffusion-Enhanced Energy Transfer

“…This value of Kw is also closer to the value determined for chromatosomal DNA (namely 6 · 10 8 M-1 ), using a filter binding assay with polyethyleneimine-treated glass fibre (38). Hence, the estimation appears rather insensitive to "edge effects" which should be present for short DNA fragments, as noticed by Pennings et al (38) for the interaction of H5 with chromatosomes and chromatosomal DNA A possible explanation may be found in the ability ofH5 to link, end-to-end, short stretches of DNA, in a more compact structure, as supported by the occurrence of circular complexes with DNA of more than 600 bp in length (11 ).It is generally believed that the affinity of H5 for DNA, core particles and chromatin, is higher than that of HI (11,(39)(40)(41)(42). This difference was attributed mainly to the higher arginine content of H5 ( 43).…”