Amelanotic melanoma Review of systems amelanotic melanoma Ⅱ 症例症例主訴現病歴, CT H & E polygonal spindle cell myxoid chondroid stroma ROS kg 図 1 副鼻腔 CT 既往歴

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1 症例報告 Review of systems Amelanotic melanoma 石井彰 1), 菅原斉 1), 渡辺珠美 1), 松本充也 1), 松林洋志 1), 出光俊郎 2), 兵頭隆史 3), 山田茂樹 3) 1), 川上正舒要旨 Review of systems ROS cm CT vimentin melanoma-associated antigen HMBS epithelial membrane antigen cytokeratin CAM.CD Amelanotic melanoma Performance Status amelanotic melanoma TNM pt N M c amelanotic melanoma ROS ROS amelanotic melanoma review of systems Ⅰ はじめに Review of system ROS ROS Amelanotic melanoma

2 Amelanotic melanoma Review of systems amelanotic melanoma Ⅱ 症例症例主訴現病歴, CT H & E polygonal spindle cell myxoid chondroid stroma ROS kg 図 1 副鼻腔 CT 既往歴内服薬 nateglinide mg glimepiride mg fluvastatin mg nicardipine LA mg 家族歴生活歴転科時身体所見 cmkg BMI kg/m. / mmhg / / cm 検査所見 TP 6.2 g/dl Alb 3.1 g/dl T-BIL 0.58 mg/dl WBC /μl AST 85 IU/dl neut 83.9 % ALT 78 IU/dl RBC /μl LD 2557 IU/dl Hb 11.4 g/dl ALP 1579 mg/dl Ht 33.5 % -GTP 470 mg/dl MCV 85.5 Na 131 meq/l PLT 45 /μl K 4.6 meq/l Cl 93 meq/l 1+ Ca 8.5 meq/l P 3.7 meq/l BUN 26 mg/dl Cr 0.62 mg /dl HB Ag FPG 171 mg/dl HCVAb HbA1c 6.9 % 表 1 尿血液生化学検査 LD

図 2 肝造影 CT 画像所見 CT CT solid component 転科後経過 ROS

HMB melanocyte S epithelial membrane antigen EMA CAM.

amelanotic melanoma TNM pt N M c amelanotic melanoma

3 図 2 肝造影 CT 画像所見 CT CT solid component 転科後経過 ROS solid pattern vimentin melanomaassociated antigen HMB melanocyte S epithelial membrane antigen EMA CAM.CD amelanotic melanoma 図 3 組織所見 HMB S 剖検所見 amelanotic melanoma TNM pt N M c amelanotic melanoma large and pleomorphic cells pattern 図 4 剖検肉眼所見 amelanotic melanoma

4 Amelanotic melanoma small blue cells pattern myxoid stroma Ⅲ 考察 ROS kg ROS amelanotic melanoma ROS Mayo Clinic ROS X ROS ROS ROS for cancer screening Schneiderman H ROS S-, HMB- vimetin S- EF-hand Thompson, HMB- gp vimentin amelanotic melanoma amelanotic melanoma Performance status Dacarbazine Ⅳ 結語 Review of systems amelanotic melanoma ROS

5 文献 review of systems: ROS. Medicine : -, Mitchell TL, Tornelli JL, Fisher TD et al.: Yield of the screening review of systems: A study on a general medical service. J Gen Intern Med :-, Boland BJ, Wollman PC and Silverstein MD: Review of systems, physical examination and routine tests for case-finding in ambulatory patients. Am J Med Sci : -, Schneiderman H: The review of systems: An impor tant par t of comprehensive examination. Postgraduate Medicine :-, Yanagi T, Akiyama M, Kasai M et al.: Multiple skin metastasis of amelanotic melanoma originating from the sinonasal mucosa. Acta Derm Venereol : -, Roth TN, Gengler C, Huber GH et al.: Outcome of sinonasal melanoma: Clinical experience and review of the literature. Head Neck : -, Thompson LDR, Wieneke JA and Miettinen M: Sinonasal tract and nasopharyngeal melanomas. Am J Surg Pathol : -, : stc/ / / _G _.html

6 Jichi Medical University Journal An autopsy case of amelanotic melanoma in which review of systems should have been performed at a specialist outpatient clinic Akira ISHII, Hitoshi SUGAWARA, Tamami WATANABE, Mitsuya MATSUMOTO, Hiroshi MATSUBAYASHI, Toshirou DEMITU, Takasi HYOUDOU, Shigeki YAMADA, and Masanobu KAWAKAMI Abstract A -year-old woman with a -month history of right nasal obstruction and an oppressive feeling in her right cheek was referred to an otolaryngologist at our center. Computed tomography (CT) scan showed a mass in the right nasal canal and maxillary sinus. Biopsy was performed through the right nasal canal; however, a diagnosis could not be made. On the admission day, she experienced a sudden loss of appetite and back discomfort. Subsequently, she was referred to the Division of General Internal Medicine. Review of systems (ROS) after the consultation indicated a weight loss of kg within months and a small subcutaneous nodule in the left lower abdomen. Tenderness of the thoracic vertebrae and right hypochondralgia were noted on examination. Enhanced CT scan showed multiple metastases to the liver and sacral bone. Immunohistochemical staining of the completely resected subcutaneous nodule was positive for S, HMB and vimentin, but was negative for epithelial membrane antigen, cytokeratin, and CD. The pathological diagnosis was that of an amelanotic melanoma. The performance status of the patient declined, and she died the th hospital day. At autopsy, the right nasal sinus was inundated with a white pultaceous mass, the histological findings of which were the same as those obtained from the previous biopsy of amelanotic melanoma, and extensive multiple metastases to the liver, lung, heart, thyroid, peritoneum, retroperitoneum, ribs, thoracic vertebrae, and iliac bone were observed. The TNM staging for malignant melanoma was pt N M c. ROS is an important tool not only for diagnosis, but also for determining the patient s general condition. Obtaining the ROS is an overarching approach for organ specialists who care for patients with malignancy; it enables them to evaluate metastasis to organs other than the target organ. Division of General Medicine, Clinical Department of Internal Medicine, Department of Dermatology Department of Pathology Saitama Medical Center, Jichi Medical University

BUN, CRP K mg/ cm, 49.6 kg, BMI /72 mmhg, 92/ Hb 6.7 g/dl PT-INR CT 1 MRI 2a, b T1 T2 T1 MRI

BUN, CRP K mg/ cm, 49.6 kg, BMI /72 mmhg, 92/ Hb 6.7 g/dl PT-INR CT 1 MRI 2a, b T1 T2 T1 MRI 20 2 2015 1 2 3 85 K CT Abstract A case of renal subcapsular hematoma resulting from trigger point injection under excessive effect of anticoagulant YAMANE Tateki, UMEDA Akira and SHIMAO Hitoshi An 85-year-old

Amelanotic melanoma Review of systems amelanotic melanoma Ⅱ 症例症例 主訴 現病歴, CT H & E polygonal spindle cell myxoid chondroid stroma ROS kg 図 1 副鼻腔 CT 既往歴

Amelanotic melanoma Review of systems amelanotic melanoma Ⅱ 症例症例主訴現病歴, CT H & E polygonal spindle cell myxoid chondroid stroma ROS kg 図 1 副鼻腔 CT 既往歴