Glomus tumor of digital nerve: case report

Post-traumatic glomus tumor of the left anterior supraclavicular nerve: a case report

OBJECTIVES

Peripheral nerve glomus tumors are extremely rare and occur with typical symptoms of peripheral neuropathic pain. Clinicians hardly consider this entity when faced with the swelling of a peripheral nerve and the diagnosis is reached only with histological examination. Nerves of limbs are usually affected and the solid glomus tumor is the most frequent histological variant.

CASE DESCRIPTION

A 55-year-old man presented with a glomus tumor of the anterior supraclavicular nerve of the left cervical plexus, misdiagnosed clinically and radiologically as neuroma. Despite the preoperative suspicion and the intraoperative appearance, the histological examination revealed a glomus tumor with a prevalent muscular component, a glomangiomyoma. Once the tumor was removed, pain regressed completely.

CONCLUSIONS

Because of its rarity, pre-operative diagnosis of glomus tumors is still a challenge, especially when arising from peripheral nerves. In the presence of chronic localized neuroma-type pain and sensitivity, glomus tumors should be considered in the pool of differential diagnosis, even if the imaging is not conclusive.

Posttraumatic Glomus Tumor of the Digital Nerve with Atypical Presentation: A Case Report

CASE

A 53-year-old man sustained an injury to his left index finger and underwent presumably traumatic neuroma excision from the radial digital nerve 2 years ago. He presented with a painful mass distal to the prior site of neuroma excision with distinctly different symptoms from those that led to his index surgery. Thus, he underwent excisional biopsy of the mass which was adherent to his radial digital nerve consistent with a benign glomus tumor on histologic examination.

CONCLUSION

Digital nerve glomus tumors are rare. In most of the cases, some portion of the digital nerve requires excision but decreased pain can be expected.

Digital Glomus Tumor: Bibliographic Review of the Studies Published over the Past 10 Years

Glomus tumors are a mostly benign neoplasm that constitutes less than 4% of upper-limb soft-tissue tumors. Its unspecific clinical presentation, added to its low frequency, leads to a late diagnosis.

The objective of the present study is to update the clinical-paraclinical approach and the surgical technique used in the treatment.

We carried out a literature review from 2014 to 2019 on digital glomus tumor in the hand in adult patients using the PubMed search engine.

In most of the publications analyzed, the diagnosis was clinical, with a delay of 1 to 10 years. Plain radiography is the most requested study; of the 16 articles reporting its indication, only half evidenced compatible changes. Magnetic resonance imaging (MRI) was requested in 15 articles, presenting normal results in 3 of them. The treatment of choice was surgical excision using a transungual approach. Only 4 articles report recurrence after excision.

Although there is diversity in the approach to these tumors, we conclude that the diagnosis is clinical, and the treatment surgical, and there is no consensus regarding the paraclinical indication. The information available comes mainly from case reports, publications that contribute to the generation of evidence for the clinical practice in rare diseases such as this one.

Epineural glomus tumor of the posterior interosseous nerve: Case report

Among peripheral nerve sheath tumors, epineural glomus tumors represent a rare differential diagnosis for peripheral nerve schwannoma, displaying the same appearance on MRI. Here we present the case of a 68-year-old man complaining of pain in the left forearm, with paresthesias in the first three fingers. MRI demonstrated a round mass along the course of the posterior interosseous nerve with homogeneous contrast enhancement. Complete surgical removal successfully relieved the symptoms. Pathological analysis led to the diagnosis of glomus tumor of uncertain malignant potential. This is to our knowledge the first reported case of epineural glomus tumor of the radial nerve.

Glomus Tumor Originating from a Digital Nerve

Glomus tumors are relatively rare benign neoplasms that most commonly occur in the hand. They arise from the normal glomus body, which is an arteriovenous shunt related to thermoregulation. Glomus tumors in nerves are an extremely rare occurrence, as normal glomus bodies have not been found in nerves. We describe the case of a 30-year-old woman with a glomus tumor originating from a digital nerve that required excision along with a nerve segment. In this case, because the tumor was inseparable from both fascicles of the nerve, a segment of the ulnar digital nerve was resected with the tumor. After tumor resection, direct nerve repair was performed and the patient showed favorable outcomes.

Multiple intraneural glomus tumors in different digital nerve fascicles

Background

Glomus tumors in the digital nerve are extremely rare. Multiple intraneural glomus tumors in different digital nerve fascicles have not been previously reported.

Case presentation

We report the case of a 54-year-old male with a 1-year history of progressive numbness of the middle finger with point tenderness at the level of the middle phalanx. Surgical incision revealed the presence of two glomus tumors within different fascicles of the ulnar digital nerve of the middle finger.

One tumor was excised along with surrounding fascicle, the other was removed leaving the fascicle intact. Subsequently, the patient regained function of the finger and no tumors have recurred.

Conclusions

Patients and physicians should be aware of the properties of intraneural glomus tumors so that early diagnosis and treatment can be sought.

Electronic supplementary material

The online version of this article (10.1186/s12885-019-6098-y) contains supplementary material, which is available to authorized users.

A painless glomus tumor: a case report

Background

Glomus tumor is a benign and vascular hamartoma that originates from the neuromyoarterial cells of the normal glomus apparatus in the reticular dermis. The etiology of glomus tumors is unknown. It usually presents as a small, slightly raised, bluish or pinkish-red, painful nodule of the fingertips and the pulp. we report an atypical case of a patient of painless glomus tumor.

Case presentation

Our patient, a 60-year-old Moroccan man, had a 2.5 cm purplish painless soft tumor, covered with melliciric and hemorrhagic crusts, involving the first phalanx of his right index finger. This tumor was compressing his nail plate. No bony lesions were identified by radiographic studies, but magnetic resonance imaging was suggestive of glomus tumor. Surgical excision was performed with directed healing.

Conclusions

The diagnosis of a glomus tumor is an eventuality even in the absence of pain.

Glomangiomatosis of the sciatic nerve: a case report and review of the literature

Glomus tumors are hamartomas, which tend to occur in sites rich in glomus bodies, such as the subungual regions of digits or the deep dermis of the palm, wrist, forearm, and foot. Very rarely, they may involve peripheral nerves. We describe a patient, who, following surgical resection of a solitary glomus tumor of the left distal sciatic nerve in his teens, had recurrence with development of multiple tumors in the course of the nerve over several years. To our knowledge, this is the only known case of glomangiomatosis involving a major peripheral nerve.

Magnetic Resonance Imaging of the Digital Nerves of the Hand: Anatomy and Spectrum of Pathology

Digital nerves are intrinsic to the sensory and motor function of the hand. These nerves represent the terminal ramifications of the ulnar, median, and radial nerves and are located distal to the carpal tunnel and Guyon canal. With magnetic resonance imaging, traumatic and nontraumatic abnormalities of the digital nerves can be shown with high contrast as well as high spatial resolution. Digital nerve abnormalities are most commonly posttraumatic in nature; however, infection, inflammatory, vascular malformations, and neoplasms can rarely occur. Magnetic resonance imaging is playing an increasing role in the assessment of peripheral nerve injury throughout the body, and in the hand, which can accurately identify the extent and character of digital nerve abnormalities before operative intervention.

Multiple intraneural glomus tumors on a digital nerve: case report

Glomus tumors are soft-tissue tumors that are commonly found in the hand. Intraneural glomus tumors, however, are rare, and the few reported cases are mostly solitary tumors. We present a woman with a symptomatic swelling on her finger whose imaging findings suggested multiple tumors on the digital nerve, most compatible with a neuroma. Surgical excision and histology, however, confirmed the presence of multiple glomus tumors of the digital nerve. The patient's symptoms resolved after surgery. We describe the biology, typical presentation, and clinico-pathologic features of glomus tumors associated with a peripheral nerve and explore issues that the clinician should consider with multiple tumors.