An excisional specimen revealed an intradermal tumor with a dome-shaped profile formed by an intermixed proliferation of ganglion cells, Schwann cells, and numerous adipocytes. Schwann and ganglion cells
expressed S100 protein, S100A6, selleck kinase inhibitor and glial fibrillary acidic protein. Ganglion cells and axonal elements expressed c-kit, synaptophysin, neurofilament, CD56, and neuron-specific enolase. Rare small tumor cells with scant cytoplasm weakly expressed microphthalmia transcription factor protein (Mitf). Similar to NMN, CGN affected the same age group, commonly occurred on the trunk, showed neuromatous differentiation, and in a minority, exhibited adipocytic metaplasia. In contrast, CGNs were significantly larger tumors with more frequent coexisting epidermal changes or desmoplasia.
No cases of NMN had authentic ganglion cells, but a minority had ganglion-like cells, which weakly expressed the neural tissue markers c-kit, neuron-specific MEK inhibitor enolase, CD56, and glial fibrillary acidic protein. A few small Mitf+ cells were found in neuromatous areas and nevic corpuscles of NMN.
Conclusions: CGN and NMN are neural crest stem cell-derived tumors that exhibit overlapping and unique phenotypic traits. Adipocytic and neuromatous metaplasia in melanocytic nevi is considered as a consequence of “”maturation.”" Although transformation of an intradermal melanocytic nevus to CGN is a theoretical possibility, the multiple coexisting phenotypes they display most likely arose ab initio in the dermis, mirroring the multiple pathways of differentiation possible for neural crest stem cells.
The stage of differentiation of the precursor selleck screening library (stem) cell and interaction with environmental influences most likely predict the final phenotype(s), a pathogenic scheme that better explains the phenomenon of NMN rather than transformation of differentiated melanocyte into a peripheral nerve sheath cell.”
“Objective: To explore the role of a four-item Global Rating Scale (GRS) that could be used in place of the Appraisal of Guidelines, Research and Evaluation II (AGREE II).
Study Design and Setting: A mixed four-factor design was used (User Type, Evaluation Type, Clinical Topic, Guideline). Participants were asked to read and evaluate a guideline using both the AGREE II draft and GRS or GRS only and to complete a series of questions regarding overall guideline quality, adoption, utility, and acceptability.
Results: One GRS item varied as a function of User Type. Each item was a significant predictor of participants’ outcome measures. All items were rated as useful by stakeholders. The GRS rating scores, outcome measures, and usefulness scores did not vary between the two Evaluation Type conditions. Correlations between the GRS and the outcome measures were stronger compared with those between the AGREE II draft and these measures.