Extradigital glomus tumors: a 20-year experience

Ethanol ablation of extradigital solid glomus tumors

Glomus tumors are predominantly benign neoplasms accounting for less than 2% of all soft tissue tumors. While generally solitary, multiple lesions have been reported in approximately 10% of cases. Glomus tumors are typically under 1 cm in dimension accompanied by the classic triad of symptoms: debilitating pain, pinpoint tenderness, and hypersensitivity to cold temperatures. Excisional therapy is the accepted standard of care, however, past reports of non-invasive treatments for multiple glomangiomata variant tumors include laser therapy, irradiation, and sclerotherapy with STS and hypertonic saline. We present a case of a patient with multiple subcutaneous and intramuscular, lower-extremity benign solid glomus tumors treated successfully utilizing ethanol ablation, which has not been previously reported. This minimally invasive treatment allowed for control of symptoms from a benign condition previously requiring multiple invasive surgeries.

Knee glomangioma: a rare location for a glomus tumor

Glomus tumor is a rare, benign neoplasm rising from the glomus apparatus of the skin. It occurs most frequently on fingers and toes and accounts for 1.6% of all soft tissue tumors. Clinical diagnosis may prove difficult if the tumor occurs on an extra digital location. We report a case of a vascular-type glomus tumor (glomangioma) found in an atypical location, namely the lateral aspect of the knee joint.

Extradigital Symplastic Glomus Tumor of the Hand: Report of 2 Cases and Literature Review

Glomus tumor is a rather common tumor of the hand, which presents with a classic triad of symptoms of high temperature, sensitivity and pain, and localized tenderness. Most glomus tumors are located in the digits, especially in subungueal areas. However, extradigital tumors are less frequent, and little is known about their clinical and histopathological features. Two cases of extradigital symplastic glomus tumor are presented. An active clinical and pathological awareness to avoid misdiagnosis or delayed diagnosis of this uncommon lesion is highlighted.

Subungual glomus cell proliferation in the toe: a case report

Glomus tumors are rare benign neoplasms. They typically present with a triad of severe pain, point tenderness, and cold sensitivity. Most glomus tumors will form well-circumscribed nodules, and excisional biopsy of masses detected by ultrasonography or magnetic resonance imaging of the lesion can relieve the symptoms. We describe a 30-year-old female patient with nontumorous glomus cell proliferation with clinical symptoms similar to those of glomus tumors. The lesion was treated by exploration and excision, with a satisfactory clinical outcome.

Glomus tumour of the elbow: a case of mistaken identity

Glomus tumours are small vascular tumours that are usually benign and rarely occur. However, atypical locations of these tumours can lead to misdiagnosis, particularly where the lesion is rarely reported. We report a case of glomus tumour located on the posterior aspect of the elbow, which was mistaken for, and treated as the commonly diagnosed, olecranon bursitis for several years. With worsening symptoms, mainly pain, pinpoint tenderness and hypersensitivity, the patient was referred for a further opinion, and the lesion was diagnosed as a glomus tumour following complete excision under anaesthesia. This present case highlights the importance in considering this rare entity in the differential diagnosis of posterior elbow swelling and pain. Furthermore, this report provides a review of the literature and identifies the need for early specialist referral to confirm diagnosis, alleviate patient symptoms and improve function.

Glomus tumor causing anterior thigh pain: a case report

Glomus tumors are a rare, benign neoplasm and 75% exist in the subungual region. Extradigital glomus tumors are much more difficult to diagnose because of their atypical location and symptoms. Furthermore, if their symptoms are similar to neuropathic pain, the patient can suffer from misdirected treatment due to misdiagnosis. It is essential to perform careful evaluation of the lesion itself in order to reduce misdiagnosis. Ultrasonography is a useful, non-invasive method that can be easily performed in the pain clinic for local evaluation and diagnosis. We report a case of misdiagnosed glomus tumor in the thigh which was properly diagnosed after ultrasonography.

Glomus tumor of a female breast: a case report and review of the literature

Glomus tumor is a benign, subcutaneous neoplasm which usually arises in areas that are rich in glomus bodies, most commonly the digital area, and usually appears as a painful nodule. Glomus tumor of the breast is extremely rare, and there has been only limited information reported in the literature to date. We herein present a case of a glomus tumor arising from the breast, showing a well-circumscribed, hypervascular, solid and hypoechoic tumor within the retromammary fat. The tumor was resected and the patient's pain was relieved immediately after the surgery. She remains well without any symptoms after a year. This report describes a unique case of this type of tumor.

A Glomus Tumour of the Elbow: A Case Report and Review of the Literature

Extradigital glomus tumours are relatively uncommon. We present a case report of a glomus tumour of the elbow and review of the literature with regards to the clinical features, work-up and management of these tumours, to highlight the importance of considering a glomus tumour as part of the differential diagnosis in patient with atypical pain around the elbow.

Paravertebral glomangioma mimicking a schwannoma

Glomus tumors are rare benign neoplasms usually arising from soft tissues. Surgical removal seems to be the best treatment. Here, we report the case of a 52-year-old female patient referred for chronicback pain, revealing a thoracic paravertebral tumor with no osseous extension. After surgical removal,this tumor turned out to be a glomangioma. Differential diagnosis with other more frequent tumors,such as schwannoma, is particularly difficult. A review of the relevant literature will be presented. A better knowledge of the natural history of those tumors, as well as the therapeutic options available, are necessary for spinal surgeons who may encounter such presentations.

[Glomus tumor of volar elbow capsule. Case report]

Glomus tumors are rare tumors, benign but painful and responsible for a major functional impairment. Although their preferential localization is digital, 35% of glomus tumors are extradigital. Ignorance of this disease characterized by atypical clinical signs and the absence of specific imaging are responsible for a significant diagnostic delay, 7 to 10 years in extradigital forms. Treatment by surgical excision simply ensures immediate disappearance of pain without recurrence in 90% of cases. It is therefore necessary to emphasize the existence of this sometimes debilitating condition benefiting from effective therapeutic solution. We report the case of a glomus tumor of the anterior capsule of the left elbow in a 24-year-old woman with a diagnostic delayed by 12 years.

A rare large tracheal glomus tumor with postoperative haematemesis

Glomus tumors are uncommon benign tumors which usually arise from the distal portion of the digits. A tracheal glomus tumor with large size is extremely rare. We present a case of a large tracheal glomus tumor that was resected using posterolateral thoracotomy and successful primary reconstruction of the trachea was achieved. Severe haematemesis happened after the patient was discharged. An emergency exploratory thoracotomy was performed but no signs of anastomotic bleeding were observed, while intraoperative gastroscopy revealed plenty of blood and blood clots in the patient's stomach. Medical treatments targeting hemorrhage of upper digestive tract were given and the patient finally recovered.

Large plaque-like glomangioma in a patient with multiple glomus tumours: review of imaging and histology

Glomus tumours are benign tumours of the temperature-sensitive neuromyoarterial glomus body, present within the dermis, which are most commonly seen as solitary subungual lesions on the arms. Multiple glomus tumours or glomangiomas are a less common subtype of extradigital glomus tumours, which very rarely present as large plaque-like dermal lesions. Glomangiomas do not often show the classic triad of symptoms associated with glomus tumours, namely: pain, point tenderness on compression, and temperature sensitivity. As a result of this and of their atypical morphology, they can often be misdiagnosed as vascular malformations (VMs), resulting in delayed diagnosis and inappropriate treatment. We report a 29-year-old man with multiple extradigital glomus tumours that had been present since childhood, with the lesion on the patient's leg being the largest plaque-like glomangioma yet reported, to our knowledge. Spectral greyscale and Doppler shift ultrasonography showed multiple, tubulonodular, ectatic, noncompressible, vascular structures with aberrant flow within the thickened dermis. Using magnetic resonance imaging, low to intermediate signal was seen on T1-weighted images and high signal on T2-weighted images, and there was florid enhancement with gadolinium, with no evidence of extension into muscle or bone. Histology showed abnormal, dilated, thin-walled, vascular channels lined with multiple layers of glomus cells, confirming the diagnosis of a glomangioma. We discuss imaging techniques for plaque-like glomangiomas, and review the clinical, radiological and histological characteristics that help differentiate them from other superficial VMs.

A rare case of a calcified glomus tumour in the thigh of an adolescent

Glomus tumours are clinically defined by a triad of symptoms, i.e. paroxysmal pain, pinpoint tenderness and hypersensitivity to cold. These tumours typically affect the upper limbs, are small in size, superficially located and mostly found in adults. During a radiologic assessment of an idiopathic scoliosis in a 13-year-old girl, we found a calcified mass lesion in the soft tissue of the proximal thigh. The child was asymptomatic. Complementary exams permitted the definition of an interfascial calcified tumour with a long axis of 50 mm, with an inferior polar soft-tissue component. After excision, the anatomical pathology analysis confirmed the diagnosis of calcified glomus tumour. This clinical and radiologic presentation is particularly uncommon for a glomus tumour, which enriches the range of differential diagnoses of calcified masses in soft tissue.

Glomus tumor of the mediastinum

Glomus tumors are rare benign myoepithelial neoplasms that can present with intractable pain. We report the case of a 59-year-old gentleman who presented with upper abdominal and chest pain caused by a posterior mediastinal glomus tumor arising from the spinal column, which required surgical resection. As glomus tumors usually develop in the limbs, this case highlights the complexity of diagnosis and treatment of glomus tumors when they present in rare locations.

Unusual motion detected on real-time sonography inside a glomus tumor in the thigh

Glomus tumors are rare and many have been reported to have a hypervascular appearance on color or power Doppler sonography. We report a pathologically proven case of superficial glomus tumor within the thigh with no detectable color flow signals on color or power Doppler sonography. In addition, real-time sonography showed spontaneous motions within the tumor, which were not synchronized with vascular or respiratory motions, and misled the presurgical diagnosis of a suspected parasite in a patient who had direct contact with multiple animal species. The etiology of this internal motion remains hypothetical but, if reconfirmed, this finding may be a useful adjunctive sign for the diagnosis of glomus tumors.

Solitary glomus tumor recurring as multiple glomus tumors

Most glomus tumors arise as a single nodule. However, up to 10 % of glomus tumors may be multiple. We report a case in which a single glomus tumor of the leg that evolved several years after surgery to multiple glomus tumors requiring additional resections.

Glomus tumor of the cheek: a case report

Glomus tumors are benign, subcutaneous neoplasms of the perivasculature. Though facial location is rare, the diagnosis of a glomus tumor should be considered in cases of undiagnosed painful facial nodules or chronic facial pain. Imaging aids in defining the tumor and planning a complete excision in order to avoid recurrence. Histological examination is mandatory after every attempted excision. A case of glomus tumor of the cheek along with the possible pitfalls of diagnosis and treatment and a brief review of the limited associated literature are presented.

Glomus tumor of digital nerve: case report

Glomus tumors consist of modified perivascular, smooth muscle involved in thermoregulatory activity of digital blood flow. Digits, especially in the subungual region, are often affected. These tumors only rarely arise in peripheral nerves; digital nerve involvement is exceptional. We describe a glomus tumor occurring in the digital nerve at the level of the distal phalanx.

Extradigit glomus tumor causing abdominal pain -a case report-

Glomus tumors are small vascular tumors that are usually benign and rarely occur. They originate from glomus bodies and present in the reticular dermis. They are clinically distinguished by their small size and their ability to cause extreme pain. Most of these tumors are subungually located. However, atypical locations of the tumors sometimes cause misdiagnosis, particularly when the lesion is rarely reported. Therefore, we report a case of glomus tumor which presented with chronic abdominal pain, found in the abdominal wall that has never been reported before.

Intravenous glomus tumour of the upper arm

Glomus tumours are rare, benign tumours of the glomus body, most frequently located in the subungual region of digits, palms and soles, but they have been reported throughout the body. Our patient is a 65-year-old man who presented with a 3-year history of a very painful area on his left upper arm. The overlying skin was normal and there was no lesion to palpate, but the symptoms were very striking, warranting further investigation. An exploratory operation identified a prominent vein with a noticeable bulge in the vessel wall. The vein was ligated and excised. On dissection of the vein, a tumour was present within its lumen. Histological examination and immune profile of the tumour confirmed an intravascular glomus tumour. Following surgical excision, symptoms resolved.

Malignant Glomus Tumor of the Leg Developed in the Context of a Superficial Typical Glomus Tumor

A 41-year-old man presented with a 2-cm painful subcutaneous nodule in his right leg, which had been present for more than 10 years and was recently enlarging. Histologically, the tumor was composed of sheets and nests of cells with variable cytomorphology, including typical round/ovoid glomus cells with clear cytoplasm and well-defined borders, small cells, and spindle cells. Numerous medium to large vessels were present. Nodules with moderate to high cellularity, nuclear atypia, and frequent mitotic figures (42 per 50 high-power fields) were noted. Immunohistochemistry showed cytoplasmic and membranous expression of smooth-muscle actin, vimentin, and membranous expression of type IV collagen. Whereas superficiality, dimensions, and long-term follow-up may suggest classification as a symplastic or uncertain potential glomus tumor (GT), histological features and immunoprofile are indicative of malignant nodules developed in a typical GT. The follow-up has been negative for recurrence/metastases. A search of the literature revealed 17 cases of malignant GTs between 1995 and 2010, all fatal, of which 10 had skin as the primary site.

Case for diagnosis. Glomus tumor

Glomus tumor is a painful tumor derived from the glomus terminal which regulates blood circulation and body temperature Despite its rarity, particular attention needs to be paid to symptoms associated with this tumor: paroxysmal pain, sensitivity to local pressure and cold, and its location - typically in the distal phalanx. Manifestation of extradigital occurrence is possible. Single lesions are most common in adult females, while multiple lesions are prevalent in children and adolescents, generally those with a positive family history. The diagnosis is clinical with the aid of ultrasonography and magnetic resonance imaging, confirmed by histopathological examination.

Glomangiomyoma of the trachea

A glomus tumor is an uncommon soft tissue tumor that is most commonly found in the subungual area and a glomus originating in the trachea is extremely rare. Histologically and ultrastructurally, these tumors have been divided into three subtypes: classic glomus tumors, glomangiomas, and glomangiomyomas. Glomangiomyomas account for less than 10% of all glomus tumors and are the least common type. We report a case of a 54-year-old man with glomangiomyoma of the trachea who presented with stridor. We treated the tumor by segmental resection and primary repair via a transcervical approach.

Glomus tumour: a retrospective review of 15 years experience in a single institution

ABSTRACT

Glomus tumours (GT), neoplasms of the glomus body comprise 4.5% of upper limb tumours. Seventy-five per cent of these occur in the hand, and most are subungual (50%). We performed a literature review and retrospective search of histopathologically confirmed GT seen from 1995 to 2009. Fifteen patients were identified, with an average age of 49.6 years. Eight were in the hand, 2 in the upper limb, 2 lower limb and 3 in the ear. Eighty-six per cent presented with pain and 50% underwent radiological investigation. Most diagnoses followed biopsy findings. Surgical excision resulted in a recurrence rate of 13%. The average time to diagnosis was 3.3 years. The average duration of symptoms was 7 to 11 years with an average of 2 to 3 consultations prediagnosis. MRI remains the most useful imaging modality (82 to 90% sensitivity). Excision biopsy is the most common treatment. Greater awareness is needed for quicker diagnosis.

KEY WORDS

Glomus Tumour, Presentation, Imaging, Recurrence.

Imaging features of glomus tumors

OBJECTIVE

To describe the imaging findings with pathologic correlation and clinical presentation of glomus tumors.

MATERIALS AND METHODS

We retrospectively searched the surgical pathology database from January 1, 1997, to April 30, 2010, for cases of pathologically proven glomus tumor. Patients who had imaging results available for review were included in the study.

RESULTS

Glomus tumors presented with a prolonged history of focal and often debilitating pain, with a mean duration of symptoms of 7.2 years. Mean tumor size was 13 mm. The upper extremity was involved in 12/25 (48%) of the tumors, the lower extremity in 12/25 (48%), and one case (4%) was within the trachea. Lesions appeared well circumscribed on ultrasonography, with marked vascularity on color Doppler evaluation. Magnetic resonance imaging (MRI) with a marker placed in the region of point tenderness was the best method for identifying small glomus tumors. These tumors had a high T2 signal and uniform enhancement after gadolinium administration.

CONCLUSIONS

The diagnosis of glomus tumor is suggested by imaging features of a small circumscribed mass at the site of point tenderness that show marked vascularity on Doppler evaluation or diffuse contrast medium enhancement on MRI, or both. Early tumor recognition allows surgical resection that completely resolves the crippling, chronic pain of these lesions.

CD34-positive expression in benign nasal glomus tumour: two case reports and a literature review

Nasal glomus tumours are extremely rare neoplasms with poorly understood histogenesis, but which are clinically recognized as benign. The neoplastic cells of glomus tumours resemble normal glomus cells and are arranged around a varying number of thin-walled, sometimes branching, capillaries. CD34 is known to be a marker of tumour progenitor cells. In this report, two cases of benign nasal glomus tumour are presented. The tumours were excised completely via endoscopic endonasal surgery under local anaesthesia. During surgery, there was little bleeding and the post-surgical course for both patients was uneventful. Tumour cells from both cases were positive for α-smooth muscle actin, actin, vimentin and CD34 protein. Thus, CD34 positivity against a background of other immunohisto chemical markers is helpful in the differential diagnosis of glomus tumours.

Clinical and pathological characteristics of extradigital and digital glomus tumours: a retrospective comparative study

BACKGROUND

Most glomus tumours are located in the digits, especially in subungual areas. Less is known, however, about the clinical characteristics of extradigital glomus tumours.

OBJECTIVES

The aim of this study was to characterize extradigital glomus tumours and compare their clinical, pathological and immunohistochemical characteristics with those of digital glomus tumours.

METHODS

We retrospectively reviewed the charts of 110 patients with digital and 42 patients with extradigital glomus tumours, treated at a single centre from 1991 to 2010. We also investigated the immunohistochemical expression of substance P and TRPV1 in the biopsy specimens from patients with digital (n = 5) and extradigital (n = 5) glomus tumours.

RESULTS

Compared with patients with digital glomus tumours, patients with extradigital tumours were significantly older (P = 0.009) and showed a significantly greater male predominance (P < 0.001), lower incidence rates of pain (P = 0.019), cold intolerance (P < 0.001) and a higher frequency of the glomangioma subtype (P < 0.001). Extradigital glomus tumours were located most frequently on the upper extremities (n = 25). The most common clinical presentations were solitary purplish papules (n = 10). Only 20% of extradigital glomus tumours were diagnosed correctly by the initial physician. Of 38 evaluable patients, 34 (89.5%) were successfully treated with simple excision without recurrence. Substance P and TRPV1 were expressed moderately to strongly in glomus cells, but there were no differences in their expression between patients with digital and extradigital glomus tumours.

CONCLUSION

Extradigital glomus tumours do not have specific clinical features such as pain, leading to frequent misdiagnosis. To prevent delay in diagnosis or misdiagnosis, it is important to increase awareness of these tumours.

Glomus tumor of the back: a rare location

A 44-year-old man presented with a 5-year history of localized pain on his back, and a 1.5-cm round, touch-induced painful mass was palpated. A subsequent diagnostic evaluation revealed the presence of a glomus tumor. Glomus tumors are rare, benign, small vascular tumors, which originate from glomus bodies present in the reticular dermis. Glomus tumors constitute less than 2.0% of all primary soft tissue tumors, approximately 80% of the lesions are located in the upper extremity, and more than 75% are subungually located. However, many locations have been reported in the literature. Nevertheless, to the best of our knowledge, this glomus tumor that occurred on the back is very rare.

Atypical glomus tumour of the wrist: a case report

Wrist glomus tumours are extremely rare. We report a case of an unusually large wrist glomus tumour with atypical presentation. Magnetic resonance imaging (MRI) findings correlated well to those previously described for digital glomus tumours. This rare differential should be considered when evaluating lesions around the wrist.

Removal of glomus tumor in the lower tracheal segment with a flexible bronchoscope: report of two cases

Tracheal glomus tumor is an extremely rare neoplasm resected mostly by open surgery or through rigid bronchoscopy. We report two cases presenting with polypoid masses arising from the tracheal membrane in the posterior wall of the lower tracheal segment. The tumor was removed by high-frequency electrocautery and flexible bronchoscopic argon-plasma coagulation, and follow-up bronchoscopy and chest CT did not reveal tumor recurrence 12 months after the operation. In patients with tracheal glomus tumor who have poor surgical tolerance or are not willing to receive an open surgery, flexible bronchoscopic tumor removal can be a good alternative to relieve the airway obstruction symptoms.

Unusual skin tumors: Merkel cell carcinoma, eccrine carcinoma, glomus tumors, and dermatofibrosarcoma protuberans

This article discusses the epidemiology, etiology, presentation, pathology, evaluation and staging, and treatment of unusual skin tumors, such as Merkel cell carcinoma, eccrine carcinoma, glomus tumors, and dermatofibrosarcoma protuberans.

Paravertebral glomangiomatosis

Glomangiomatosis is benign but may manifest as diffusely, locally infiltrating lesions and recur after simple excision. However, conservative treatment should be advocated. The authors report a recent case in which the lesion occurred in the paravertebral area. The patient was a 39-year-old Chinese man who complained of chronic lumbago for 20 years. The clinicopathological features, in conjunction with the immunostaining pattern and ultrastructural features, confirmed the diagnosis. Glomangiomatosis is an extremely rare soft-tissue lesion. To the best of authors' knowledge, only 10 cases have been reported in the English-language literature worldwide, and the current case is the first to represent a lesion arising from the paravertebral area. The authors review the English-language literature in glomangiomatosis.

[A glomus tumor of the toe: a pediatric case report]

SUMMARY

A glomus tumour of the third toe is quite rare in children. The authors report a clinical observation based on a misdiagnosis due to insufficient investigations, which led to a mistaken referral to a pediatric psychiatrist. Preoperative diagnosis requires a targeted MRI. Complete resection of the tumor results in an immediate resolution of the pain.