Squamous Cell Carcinoma Associated with Arsenic Keratosis in a Psoriasis Patient Treated with Ustekinumab: A Case Report / 대한피부과학회지

A 53-year-old Korean woman with known history of psoriasis and treatment with ustekinumab over 16 months, presented with a nontender erythematous plaque with oozing noted on her left sole. Histopathologic examination of the lesion confirmed squamous cell carcinoma (SCC). Although use of ustekinumab was considered a possible risk factor for the development of SCC, administration of ustekinumab was continued per her request following an operation for removal of the SCC. And 19 months later, newly developed multiple hyperkeratotic papules on her soles were diagnosed as arsenic keratosis based on her past history of consumption of Chinese traditional herbal medicine. I concluded that SCC in this patient was not caused by ustekinumab, but was associated with arsenic keratosis. This case emphasizes that screening for risk factors associated with skin malignancies, such as exposure to arsenic or presence of arsenic keratosis, should be performed prior to using biologics in Korean psoriasis patients.

A Case of Primary Cutaneous CD30 Positive Anaplastic Large Cell Lymphoma in a Patient with Mycosis Fungoides / 대한피부과학회지

A 29-year-old Korean man presented with erythematous nodules on his right arm and left leg. He had been diagnosed with mycosis fungoides 10 years prior and was treated with phototherapy continuously. A diagnostic skin biopsy was performed, and the histopathologic findings of the specimen revealed dense infiltration of atypical large lymphoid cells through the entire dermis. These cells showed positive CD3 and CD30 staining. Despite the atypical finding that T cells represented less than 75% of the infiltrated cells, primary cutaneous CD30 positive anaplastic large cell lymphoma was ultimately diagnosed based on the overall consideration of the clinical features and favorable prognosis. Because primary cutaneous CD30 positive anaplastic large cell lymphoma has a favorable prognosis, it should be differentiated from large cell transformation of mycosis fungoides, which has a poor prognosis and requires aggressive treatment. However, this differential diagnosis is challenging. Herein, we report a rare case of primary cutaneous CD30 positive anaplastic large cell lymphoma with mycosis fungoides differentially diagnosed from large cell transformation.

Laparoscopic Right Hemicolectomy and Cholecystectomy for a Cholecystocolic Fistula

A cholecystocolic fistula (CF) is an uncommon complication of the gallbladder and colonic disease. We report a case of a CF that was successfully managed by using a laparoscopic right hemicolectomy and cholecystectomy. A 49-yr-old woman was admitted to the Department of Internal Medicine because of intermittent and progressive right upper quadrant pain. She was obese (body mass index: 34 kg/m2) and had a previous history of three abdominal surgeries. She was diagnosed with a CF by using abdominal computed tomography. The fistula between the gallbladder and the hepatic flexure of the colon was also characterized by using technetium-99m diisopropyl iminodiacetic acid ((99m)Tc-DISIDA) cholescintigraphy, a double-contrast Barium enema, and colonoscopy. Multiple polyps with severe inflammation were observed around the orifice of the fistula. Because of the risk of malignancy and appendicolith on CT, a laparoscopic en block excision of the gallbladder and the right colon following adhesiolysis was performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. This case shows that the laparoscopic combined resection is safe and effective in the experienced hands of the laparoscopic surgeon even though a CF has traditionally been considered as a contraindication to laparoscopic surgery. While the incidence of successful management of biliary-enteric fistulas through laparoscopic repair is increasing, this is the first report of a laparoscopic combined resection of a CF in an obese patient with severe intraabdominal adhesion.