Multiple glomangiomas: Potential for confusion with blue rubber bleb nevus syndrome

Glomovenous malformation secondary to a heterozygous nonsense variant in GLMN: a clinical mimicker of blue rubber bleb naevus syndrome

We present a case of multiple familial cutaneous venous malformations secondary to glomovenous malformation. This case illustrates the importance of considering alternative diagnoses, obtaining histology from venous lesions and genetic testing to help guide optimal management in cases of familial multiple cutaneous venous malformations.

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.

[Lipofibromatosis in the finger of a child]

BACKGROUND

Lipofibromatosis is a recently classified form of benign tumor in children; it is of non-specific clinical presentation and is seen mainly on the extremities. We report a case involving the index finger of a child.

PATIENTS AND METHODS

An 8-year-old boy consulted for a nodule on the palmar surface of the left index finger that had appeared 6 months earlier. The nodule, which adhered to the deeper skin, measured 1cm in diameter and was bluish and firm on palpation. Histological examination of the resected specimen revealed fatty tissue associated with a proliferation of spindle cells. Immunohistochemical analysis showed that certain of these cells expressed smooth muscle actin, suggesting partial myofibroblastic differentiation. A diagnosis of lipofibromatosis was made.

DISCUSSION

Lipofibromatosis is a rare tumor. The main problem in terms of severity is its locally invasive development, which frequently causes problems for resection. Due to the age at onset, its course with deep invasion, the frequency of recurrence and the histological aspect, lipofibromatosis is classed as a form of childhood fibromatosis.

Localized multiple glomangiomas on the foot

We report a 15-year-old Japanese male with multiple, soft, blue and painless nodules on the left foot. The lesions had developed when the boy was 3 years old, and had enlarged gradually thereafter. None of his family members had any similar eruptions. All the lesions were resected under local anesthesia. Histological examination revealed cystically dilated spaces lined by endothelial cells and a few outer layers of glomus cells in the dermis and fat tissue. Immunohistochemistry demonstrated that the tumor cells were positive for alpha-smooth muscle actin. We diagnosed this case as localized multiple glomangioma. Multiple glomus tumors are much less common than solitary ones, and localized multiple glomus tumors are extremely rare. Because the clinical differential diagnosis of multiple glomangiomas includes common venous malformation, particularly blue rubber bleb nevus syndrome, histopathological studies should be performed.

Dermoscopic features in Bean (blue rubber bleb nevus) syndrome

Dermoscopy has become an important tool for evaluating skin lesions in children. We report the dermoscopic findings in a case of Bean syndrome and emphasize the utility of this technique in vascular lesions.