研究者詳細 - 宇原　久

論文 - 宇原　久

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頭部血管肉腫の5例

葭矢裕之, 芦田敦子, 村田浩, 宇原久, 奥山隆平

日本皮膚悪性腫瘍学会学術大会プログラム・抄録集 ( (一社)日本皮膚悪性腫瘍学会 ) 28回 132 - 132 2012年06月

ダーモスコピー、サージカルテープ、高周波エコーの併用による基底細胞癌の境界の推測

林宏一, 宇原久, 古賀弘志, 奥山隆平

日本皮膚悪性腫瘍学会学術大会プログラム・抄録集 ( (一社)日本皮膚悪性腫瘍学会 ) 28回 126 - 126 2012年06月

Applicability of radiocolloids, blue dyes and fluorescent indocyanine green to sentinel node biopsy in melanoma

Hisashi Uhara, Naoya Yamazaki, Minoru Takata, Yuji Inoue, Akihiro Sakakibara, Yasuhiro Nakamura, Keisuke Suehiro, Akifumi Yamamoto, Riei Kamo, Kosuke Mochida, Hideya Takenaka, Toshiharu Yamashita, Tatsuya Takenouchi, Shusuke Yoshikawa, Akira Takahashi, Jiro Uehara, Mikio Kawai, Hiroaki Iwata, Takafumi Kadono, Yoshitaka Kai, Shoichi Watanabe, Satoru Murata, Tetsuya Ikeda, Hidekazu Fukamizu, Toshihiro Tanaka, Naohito Hatta, Toshiaki Saida

JOURNAL OF DERMATOLOGY ( WILEY-BLACKWELL ) 39 ( 4 ) 336 - 338 2012年04月 [査読有り]

Patients with primary cutaneous melanoma underwent sentinel node (SN) mapping and biopsy at 25 facilities in Japan by the combination of radiocolloid with gamma probe and dye. Technetium-99m (99mTc)-tin colloid, 99mTc-phytate, 2% patent blue violet (PBV) and 0.4% indigo carmine were used as tracers. In some hospitals, 0.5% fluorescent indocyanine green, which allows visualization of the SN with an infrared camera, was concomitantly used and examined. A total of 673 patients were enrolled, and 562 cases were eligible. The detection rates of SN were 95.5% (147/154) with the combination of tin colloid and PBV, 98.9% (368/372) with the combination of phytate and PBV, and 97.2% (35/36) with the combination of tin colloid or phytate and indigo carmine. SN was not detected in 12 cases by the combination method, and the primary tumor was in the head and neck in six of those 12 cases. In eight of 526 cases (1.5%), SN was detected by PBV but not by radiocolloid. There were 13 cases (2.5%) in which SN was detected by radiocolloid but not by PBV. In 18 of 36 cases (50%), SN was detected by radiocolloid but not by indigo carmine. Concomitantly used fluorescent indocyanine green detected SN in all of 67 cases. Interference with transcutaneous oximetry by PVB was observed in some cases, although it caused no clinical trouble. Allergic reactions were not reported with any of the tracers. 99mTc-tin colloid, 99mTc-phytate, PBV and indocyanine green are useful tracers for SN mapping.

DOI

Surgical treatment of nail apparatus melanoma in situ: The use of artificial dermis in reconstruction

Koichi Hayashi, Hisashi Uhara, Hiroshi Koga, Ryuhei Okuyama, Toshiaki Saida

Dermatologic Surgery 38 ( 4 ) 692 - 694 2012年04月 [査読有り]

DOI PubMed

Mutation analysis of BRAF and KIT in circulating melanoma cells at the single cell level

K. Sakaizawa, Y. Goto, Y. Kiniwa, A. Uchiyama, K. Harada, S. Shimada, T. Saida, S. Ferrone, M. Takata, H. Uhara, R. Okuyama

British Journal of Cancer 106 ( 5 ) 939 - 946 2012年02月 [査読有り]

Background: The availability of molecular-targeted therapies for the treatment of melanoma has emphasised the need to identify mutations in target genes such as BRAF and KIT. Circulating tumour cells (CTC) are present in the peripheral blood of a significant proportion of cancer patients.Methods:High molecular weight melanoma-associated antigen (HMW-MAA) was used to isolate melanoma cells from peripheral blood as it is selectively expressed at high levels on melanomas. The HMW-MAA-positive cells were isolated using immunomagnetic beads. After removing CD45 + cells, CTC were identified by staining with MART-1-and gp100-specific antibodies (HMW-MAA , CD45 + , MART-1/gp100 + ). Single, isolated CTC were then subjected to BRAF and KIT mutational analysis.Results:CTC (HMW-MAA , CD45 - , MART-1/gp100 + ) were isolated from the blood of 11 patients and BRAF and KIT were sequenced in nine and four patients, respectively. The BRAF sequences identified in the CTC were inconsistent with those identified in autologous melanoma tumours in three patients and the KIT sequences were inconsistent in three patients. In addition, polyclonal BRAF mutations were identified in one patient and concomitant mutations in BRAF and KIT were identified in another patient.Conclusion:Melanoma cells show clonal heterogeneity. Therefore, CTC genotyping may be crucial for successful molecular-targeted therapy. © 2012 Cancer Research UK All rights reserved.

DOI PubMed

Prediction of additional lymph node positivity and clinical outcome of micrometastases in sentinel lymph nodes in cutaneous melanoma: a multi-institutional study of 450 patients in Japan.

Kenjiro Namikawa, Naoya Yamazaki, Yasuo Nakai, Hironobu Ihn, Yasushi Tomita, Hisashi Uhara, Tatsuya Takenouchi, Yoshio Kiyohara, Yoichi Moroi, Yuhei Yamamoto, Fujio Otsuka, Hideki Kamiya, Hajime Iizuka, Naohito Hatta, Takafumi Kadono

The Journal of dermatology 39 ( 2 ) 130 - 7 2012年02月 [査読有り] [国際誌]

Various microscopic classifications of metastatic sentinel lymph nodes (SLN) have been reported along with predictors of additional lymph node positivity and their correlations with the prognosis. The purpose of this study was to re-evaluate these classifications in the Japanese population. We selected the following three classifications, based on the procedural simplicity of the measurements: maximum diameter (maximum diameter of the largest tumor lesion in the SLN; <0.1, 0.1-1.0, >1.0 mm), invasion depth (depth of tumor invasion measured from the capsule in the SLN; SI ≤ 0.3 mm, SII >0.3 to ≤ 1.0 mm, SIII >1.0 mm), and microanatomic location (microanatomic location of the tumor deposits within the SLN; "subcapsular", "parenchymal", "combined", "multifocal", "extensive"). A retrospective study, using prescribed survey forms, was carried out. Among the 450 patients, including the 149 cases with SLN metastasis, an additional lymph node positivity rate of 0% could be predicted only in patients with a maximum diameter category of less than 0.1 mm. As compared with that in the SLN metastasis-negative cases, however, the prognosis was poorer in cases with SLN metastasis, even those with lesions falling under the maximum diameter category of less than 0.1 mm, invasion depth category of SI (≤ 0.3 mm) and microanatomic location category of subcapsular. The prognosis is particularly poor for the microanatomic location category of extensive, which should thus be regarded as a macrometastasis. A prospective study with standardized procedures, including pathological evaluation, is needed in order to confirm our conclusion.

DOI PubMed

温熱負荷試験で誘発できた血管浮腫の1例

小林彩, 芦田敦子, 木庭幸子, 宇原久

日本皮膚科学会雑誌 ( (公社)日本皮膚科学会 ) 122 ( 2 ) 418 - 418 2012年02月

温熱負荷試験で誘発できた血管浮腫の1例

小林彩, 芦田敦子, 木庭幸子, 宇原久

日本皮膚科学会雑誌 ( (公社)日本皮膚科学会 ) 122 ( 1 ) 106 - 107 2012年01月

ダカルバジン単剤投与が奏効した進行期悪性黒色腫の1例

内山龍平, 井出葉子, 皆川茜, 古賀弘志, 木庭幸子, 宇原久, 高田実, 斎田俊明, 蔵井誠

Skin cancer : official organ of the Japanese Society for Skin Cancer = 皮膚悪性腫瘍研究会機関誌 ( 日本皮膚悪性腫瘍学会 ) 26 ( 2 ) 139 - 142 2011年09月

40歳代，男性。初診の3ヵ月前に健診で胸部異常陰影を指摘された。胸部CT検査で左肺下葉に約7cm大の腫瘤を認め，気管支鏡検査による細胞診で悪性黒色腫と診断された。全身検索で右後腹膜，中脳水道，右側頭葉にも転移巣を認めたが，原発と思われる色素性病変は発見できなかった。原発不明の肺転移，脳転移，後腹膜転移を来した悪性黒色腫と診断した。脳転移巣にガンマナイフを施行後，ダカルバジン250mg/m²/day×5日間を開始した。1コース終了後より肺転移，右後腹膜転移の縮小を認め，3コース終了後，肺転移はRECISTで55.8％の縮小を示した。6コース終了後（ガンマナイフ施行後より25週後）に残存肺転移巣の切除を行った。切除4ヵ月後に新たな転移巣が縦隔，膵臓，腸間膜，副腎に出現した。脳転移にはガンマナイフを，縦隔には放射線照射を行い，シスプラチンによる化学療法を行ったが，効果はみられず，初診から20ヵ月後に永眠された。集学的治療が奏功した症例と思われた。

DOI CiNii

Characteristic distribution of melanin columns in the cornified layer of acquired acral nevus: An important clue for histopathologic differentiation from early acral melanoma

Toshiaki Saida, Hiroshi Koga, Yasufumi Goto, Hisashi Uhara

American Journal of Dermatopathology 33 ( 5 ) 468 - 473 2011年07月 [査読有り]

Clinical and histopathologic differentiation between early acral melanoma and acral nevus is often difficult. Dermoscopy is helpful in this differentiation. On dermoscopy, early acral melanoma shows the parallel ridge pattern showing band-like pigmentation on the ridges of the surface skin markings, whereas a representative dermoscopic pattern in acquired acral nevus is the parallel furrow pattern showing parallel linear pigmentation along the surface furrows. The parallel furrow pattern suggests that melanocytes of acral nevus preferentially proliferate in the crista profunda limitans, an epidermal rete ridge underlying the surface furrow. In the present study, however, we found that in 13 of 18 acquired acral nevi, proliferation of melanocytes were detected not only in the crista profunda limitans but also in the crista profunda intermedia (CPI), an epidermal rete ridge underlying the surface ridge. Very interestingly, Fontana-Masson staining of these acral nevi revealed that even when proliferation of melanocytes was prominent in the CPI, melanin granules in the cornified layer were observed as regular melanin columns situated under the surface furrows and were hardly detected under the surface ridges. These findings indicate that in acral nevus, melanin granules produced by melanocytes in the CPI are not transferred to the upper epidermis. Hence, we must be careful not to overdiagnose an acral melanocytic lesion in which an increased number of melanocytes are detected in the CPI. Even in such a case, if melanin granules in the cornified layer are detected as melanin columns regularly distributed under the surface furrows, the lesion is strongly suggested to be a benign acral nevus. Copyright © 2011 by Lippincott Williams & Wilkins.

DOI PubMed

Thermal angiooedema induced by hot water

Aya Kobayashi, Hisashi Uhara, Atsuko Ashida, Yukiko Kiniwa, Ryuhei Okuyama

Acta Dermato-Venereologica 91 ( 3 ) 343 - 344 2011年05月 [査読有り]

DOI PubMed

喉頭狭窄をきたした後天性表皮水疱症の1例

木庭幸子, 大橋敦子, 芦田敦子, 宇原久, 鬼頭良輔, 福田俊平, 橋本隆, 奥山隆平

日本皮膚科学会雑誌 ( (公社)日本皮膚科学会 ) 121 ( 3 ) 585 - 585 2011年03月

Key points in dermoscopic differentiation between early acral melanoma and acral nevus

Toshiaki Saida, Hiroshi Koga, Hisashi Uhara

Journal of Dermatology 38 ( 1 ) 25 - 34 2011年01月 [査読有り]

Acral skin is the most prevalent site of malignant melanoma in non-Caucasian populations. On acral skin, other various kinds of pigmented lesions are also detected. Particularly, melanocytic nevus is commonly seen on acral volar skin approximately 10% of Japanese have a nevus on their soles. Prognosis of acral melanoma is still generally poor because of delayed detection in the advanced stages. To improve the prognosis, early detection is essential. Early acral melanoma is seen as a brownish macule, which is clinically quite similar to acral nevus. Therefore, clinicians often face a dilemma when they see a pigmented macule on acral volar skin. Introduction of dermoscopy was a great epoch in this field. Pigmentation pattern on dermoscopy is completely opposite between early acral melanoma and acral nevus pigmentation on the ridges of the surface skin markings is detected in early acral melanoma, whereas pigmentation along the furrows of the skin markings is seen in acral nevus. We termed these dermoscopic patterns the parallel ridge pattern and the parallel furrow pattern, respectively. These features are highly helpful in the differentiation between the two biologically distinct entities. The sensitivity and specificity of the parallel ridge pattern in diagnosing early acral melanoma is 86% and 99%, respectively. However, we must be aware that dermoscopic features in acral nevus sometimes mimic the parallel ridge pattern and that other conditions also could show dermoscopic features similar to the parallel ridge pattern. In this review article, we summarize key points of the dermoscopic diagnosis of early acral melanoma and then describe the three-step algorithm for the management of acral melanocytic lesions, which surely aids us in effectively detecting early acral melanoma and in reducing unnecessary resection of benign nevus. © 2011 Japanese Dermatological Association.

DOI PubMed

Key point in dermoscopic differentiation between early nail apparatus melanoma and benign longitudinal melanonychia

Hiroshi Koga, Toshiaki Saida, Hisashi Uhara

Journal of Dermatology 38 ( 1 ) 45 - 52 2011年01月 [査読有り]

Longitudinal melanonychia presents in various conditions including neoplastic and reactive disorders. It is much more frequently seen in non-Caucasians than Caucasians. While most cases of nail apparatus melanoma start as longitudinal melanonychia, melanocytic nevi of the nail apparatus also typically accompany longitudinal melanonychia. Identifying the suspicious longitudinal melanonychia is therefore an important task for dermatologists. Dermoscopy provides useful information for making this decision. The most suspicious dermoscopic feature of early nail apparatus melanoma is irregular lines on a brown background. Evaluation of the irregularity may be rather subjective, but through experience, dermatologists can improve their diagnostic skills of longitudinal melanonychia, including benign conditions showing regular lines. Other important dermoscopic features of early nail apparatus melanoma are micro-Hutchinson's sign, a wide pigmented band, and triangular pigmentation on the nail plate. Although there is as yet no solid evidence concerning the frequency of dermoscopic follow up, we recommend checking the suspicious longitudinal melanonychia every 6 months. Moreover, patients with longitudinal melanonychia should be asked to return to the clinic quickly if the lesion shows obvious changes. Diagnosis of amelanotic or hypomelanotic melanoma affecting the nail apparatus is also challenging, but melanoma should be highly suspected if remnants of melanin granules are detected dermoscopically. © 2011 Japanese Dermatological Association.

DOI PubMed

ホワイトボードマーカーによる皮野の染色はダーモスコピー診断に役立つ

宇原久, 古賀弘志, 高田実, 斎田俊明

日本皮膚科学会雑誌 ( (公社)日本皮膚科学会 ) 120 ( 3 ) 747 - 747 2010年03月

Tetracycline and niacinamide control bullous pemphigoid but not pemphigus foliaceus when these conditions coexist

Junko Shiohara, Kanako Yoshida, Junichi Hasegawa, Hisashi Uhara, Minoru Takata, Toshiaki Saida, Bungo Oyama, Takashi Hashimoto

Journal of Dermatology ( Blackwell Publishing Ltd ) 37 ( 7 ) 657 - 661 2010年 [査読有り]

Pemphigus and pemphigoid are different types of autoimmune bullous disease and can occur in the same patient. We report a female patient with this condition. At first, we diagnosed her with bullous pemphigoid, and we treated her with tetracycline, niacinamide and a topical steroid. Tense bullas disappeared shortly after that, but crusted erythemas mainly on her head and trunk persisted. We examined BP180 and desmoglein 1 enzyme-linked immunosorbent assays, and also histological features, which showed coexistence of bullous pemphigoid and pemphigus foliaceus concurrently. Therefore, we tried prednisolone, which could control both conditions. This case showed that tetracycline and niacinamide could control bullous pemphigoid, but could not control pemphigus foliaceus, and that prednisolone was effective for both conditions. © 2010 Japanese Dermatological Association.

DOI PubMed

High-frequency 30-MHz sonography in preoperative assessment of tumor thickness of primary melanoma: Usefulness in determination of surgical margin and indication for sentinel lymph node biopsy

Koichi Hayashi, Hiroshi Koga, Hisashi Uhara, Toshiaki Saida

International Journal of Clinical Oncology 14 ( 5 ) 426 - 430 2009年10月 [査読有り]

Background: High-frequency sonographic imaging has been used for the preoperative evaluation of primary malignant melanoma. In the present study, to identify the usefulness of 30-MHz sonography for determination of the surgical margin and indication for sentinel lymph node biopsy, the correlation between sonometric and histometric tumor thickness was investigated. Methods: A total of 74 primary melanomas, in patients seen at the dermatology clinic, Shinshu University Hospital, from 1998 to 2006, were evaluated using high-frequency sonographic equipment with two probes (15 MHz and 30 MHz), and tumor thickness was measured using electronic calipers before surgical treatment. All the primary lesions were surgically excised and Breslow's tumor thickness was measured histologically. Results: In 68 melanomas, excluding 2 lesions of melanoma in situ and 4 lesions with poor sonographic images, sonographic and histologic thickness showed good correlation (r = 0.887). Particularly, in 26 melanomas affecting the soles of the feet, sonographic and histologic thickness showed excellent correlation (r = 0.945). Regarding the T categorization, in which T1-T4 are divided at 1, 2, and 4 mm in thickness, the categories determined with sonometry corresponded very well to those determined with histometry. The correspondence was particularly excellent in thinner primary lesions with thickness around 1 mm. We excised almost all these primary melanomas with surgical margins based on the sonometric thickness. In 22 patients with sonometric thickness more than 1 mm, sentinel lymph node biopsy and/or radical lymphadenectomy was performed. Conclusion: High-frequency sonography (30-MHz) is very useful in the preoperative prediction of tumor thickness, particularly in thinner primary lesions, which allows us to determine surgical margins and indication for sentinel lymph node biopsy. © 2009 Japan Society of Clinical Oncology.

DOI PubMed

Transient myeloproliferative disorder with vesiculopustular eruption: Early smear is useful for quick diagnosis

Hisashi Uhara, Masaaki Shiohara, Atsushi Baba, Junko Shiohara, Toshiaki Saida

Journal of the American Academy of Dermatology 60 ( 5 ) 869 - 871 2009年05月 [査読有り]

We report a male infant with Down syndrome who had a transient myeloproliferative disorder associated with skin lesions. He was transferred to a neonatal intensive care unit because of low body weight, fetal edema, disseminated intravascular coagulation, and 10% blast cells in the peripheral blood. On postnatal day (PD) 1, erythema with small papules, vesicles, and pustules appeared on the entire body. A smear preparation from the pustules on PD 2 showed 10% blast cells. A biopsy specimen taken on PD 5 revealed subcorneal pustules containing neutrophils and eosinophils. Genetic analyses detected a somatic mutation (197G> T, Glu295Stop) in exon 2 of GATA-1. On PD 10, the eruptions resolved spontaneously and the population of blast cells in peripheral blood decreased to 1%. The number of blast cells in pustules decreased markedly after three days. Therefore, we recommend that cytologic examination should be performed as early as possible. © 2008 American Academy of Dermatology, Inc.

DOI PubMed

Reversible extensive leukoencephalopathy in Sweet disease: A case report

Kazuhiro Fukushima, Akiyo Hineno, Minori Kodaira, Kazuko Machida, Wataru Ishii, Tomoki Kaneko, Hisashi Shimojo, Hisashi Uhara, Kanji Yamamoto, Hiroshi Morita, Kunihiro Yoshida, Shu-ich Ikeda

Journal of the Neurological Sciences 275 ( 1-2 ) 178 - 180 2008年12月 [査読有り]

Sweet disease, also known as acute febrile neutrophilic dermatosis, is an idiopathic multisystem inflammatory disorder characterised by erythematous skin lesions and fever. "Neuro-Sweet disease" is a rare central nervous system involvement that coexists with the characteristic cutaneous lesions of Sweet disease. Here, we report a case of Sweet disease complicated with acute encephalopathy. This case showed extensive lesions in the cerebral white matter on magnetic resonance imaging (MRI) and high protein concentration in the cerebrospinal fluid (CSF) without pleocytosis. After steroid therapy, the patient's clinical syndrome recovered completely with no significant neurological deficits or abnormal findings on brain MRI, and normalization of the high CSF protein concentration. Both clinical and MRI findings suggested that the marked leukoencephalopathy in this case was mainly due to reversible oedema rather than destructive structural alterations in the cerebral parenchyma. © 2008 Elsevier B.V. All rights reserved.

DOI PubMed

Surgical treatment for anorectal malignant melanoma: report of five cases and review of 79 Japanese cases

Satoshi Ishizone, Naohiko Koide, Fumitoshi Karasawa, Noriyuki Akita, Futoshi Muranaka, Hisashi Uhara, Shinichi Miyagawa

INTERNATIONAL JOURNAL OF COLORECTAL DISEASE ( SPRINGER ) 23 ( 12 ) 1257 - 1262 2008年12月 [査読有り]

Anorectal malignant melanoma (AMM) is a relatively rare disease. Because of its poor prognosis, the optimal surgical treatment for AMM is still controversial and difficult to determine. In this paper, we report five cases of AMM that have been treated by surgery and/or other methods at Shinshu University Hospital within the last decade. We also review the present five cases along with 74 other Japanese cases reported between 1997 and 2006 and discuss the role of surgery in the treatment of AMM. Among our AMM patients, two who underwent radical abdominoperineal resection had long survival, while the other three patients who underwent palliative surgery had a poor outcome. On the total of 79 AMM patients, those who underwent curative surgery had a better outcome than those who underwent palliative surgery (p < 0.0001). Furthermore, the outcome of AMM patients at stages 0 and I was better than that of AMM patients at stages II, III, and IV (p < 0.0001). There was no significant difference in survival between AMM patients with and without adjuvant chemotherapy. In conclusion, AMM patients treated by curative surgery can expect long-term survival, although the usefulness of adjuvant chemotherapy for AMM patients is controversial.

DOI

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