[CME: Chronic Generalized Pruritus without Dermatological Cause]. / CME: Chronisch generalisierter Pruritus nicht-dermatologischer Ursache.

CME: Chronic Generalized Pruritus without Dermatological Cause Abstract. Chronic generalized pruritus is a common symptom. Dermatological causes must be distinguished from non-dermatological causes. Non-dermatological chronic pruritus has many causes, such as systemic, infectious, neurological, psychogenic disorders, and drug-related side effects, some of which may be associated with significant morbidity. The possibility of a systemic disease should be considered in patients with generalized pruritus and no signs of primary skin lesions. In addition to a careful history and physical examination, selected laboratory examinations can be helpful in making a diagnosis. Pruritus can be the first sign of a malignant hematological disease. Pruritus associated with solid tumors is not that rare. This article offers an approach to chronic generalized pruritus in adults without concomitant skin changes with a viable clarification strategy and consideration of the most important differential diagnoses.

[CME-Answers: CME: Chronic Generalized Pruritus without Dermatological Cause]. / CME-Antworten: Chronisch generalisierter Pruritus nicht-dermatologischer Ursache.

CME-Answers: CME: Chronic Generalized Pruritus without Dermatological Cause Abstract. Chronic generalized pruritus is a common symptom. Dermatological causes must be distinguished from non-dermatological causes. Non-dermatological chronic pruritus has many causes, such as systemic, infectious, neurological, psychogenic disorders, and drug-related side effects, some of which may be associated with significant morbidity. The possibility of systemic disease should be considered in patients with generalized pruritus and no signs of primary skin lesions. In addition to a careful history and physical examination, selected laboratory examinations can be helpful in making a diagnosis. Pruritus can be the first sign of malignant hematological disease. Pruritus associated with solid tumors is not that rare. This article offers an approach to chronic generalized pruritus of adults without concomitant skin changes with a possible clarification strategy and explanation of the most important differential diagnoses.

Dramatic and durable efficacy of imatinib in an advanced angiosarcoma without detectable KIT and PDGFRA mutations.

The tyrosine kinase (TK) inhibitor, imatinib, has revolutionized therapy of malignancies that are addicted to one of its target kinases, c-abl, c-kit and PDGF-R. This addiction is generally dependent on the acquisition of an activating kinase mutation, e.g., the bcr-abl fusion gene in chronic myeloid leukemia, or point mutations of KIT or PDGFRA in gastrointestinal stroma tumors (GIST). Other types of sarcomas are generally considered to be insensitive to imatinib. We have observed a striking and durable remission of an advanced angiosarcoma to imatinib that can only be explained by TK addiction. Unexpectedly, GIST-type KIT and PDGFRA mutations were absent in this case. This case illustrates the diagnostic challenges in identifying individual candidate patients for TK inhibitor therapy.

F-18 2-fluoro-2-deoxy-glucose positron emission tomography/computed tomography for the detection of radicular and peripheral neurolymphomatosis: correlation with magnetic resonance imaging and ultrasound.

Neurolymphomatosis is an uncommon extranodal manifestation of non-Hodgkin lymphoma. It may mimic a broad variety of neurologic conditions which renders clinical diagnosis challenging. As blind nerve biopsy is invasive and may be false negative, surrogate criteria for the diagnosis of neurolymphomatosis have been proposed based on magnetic resonance imaging/computed tomography findings. However, these morphologic modalities may suffer from limited sensitivity. Recently, a few reports have been published that discuss a possible advantage of F-18 2-fluoro-2-deoxy-glucose positron emission tomography/computed tomography (F-18 FDG PET/CT) in these patients.We report the case of a 41-year-old man who presented with progressive tetraparesis and dysaesthesia, in which F-18 FDG PET/CT aided to the diagnosis of neurolymphomatosis due to a large B-cell lymphoma. The patient received chemotherapy (R-CHOP) and the neurologic symptoms were clearly regressive. Three months after the end of systemic chemotherapy the patient presented again with progressive neurologic symptoms. A second PET/CT was performed and demonstrated disease recurrence in the right testis as well as widespread neurolymphomatosis. Additional ultrasound and magnetic resonance imaging examinations were performed and confirmed infiltration of the left brachial plexus, the right femoral, and the right sciatic nerve.We present this case to support the hypothesis that F-18 FDG PET/CT is a valuable imaging modality in patients with suspected neurolymphomatosis. It allows one to accurately determine the extent of the disease in a single whole-body examination.