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Stacy GS, Cipriani NA. Glomus tumours of the knee: a case series. Clin Radiol 2023; 78:e123-e130. [PMID: 36333129 DOI: 10.1016/j.crad.2022.09.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 01/12/2023]
Abstract
AIM To review clinical and magnetic resonance imaging (MRI) features of patients with glomus tumour of the knee, and compare the present findings with cases from the English literature. MATERIALS AND METHODS The orthopaedic oncology and pathology databases at The University of Chicago were reviewed for cases of glomus tumour and small subcutaneous anterior knee masses. For all glomus tumours, the site of the tumour and age and sex of the patient were recorded. For those tumours arising in the knee, the symptom profile and MRI characteristics were recorded. The English literature was reviewed for cases describing glomus tumours in the knee. RESULTS Thirty-four patients with glomus tumour were recorded. Five glomus tumours occurred in the anterior knee, all in men aged ≥30 years, four of whom had a several-year history of pain prior to diagnosis. MRI showed small (<2 cm) nodular enhancing masses. Review of the English literature supports the anterior knee as a common location for lower-extremity glomus tumours, with a male predominance and several years of pain preceding diagnosis. CONCLUSION Although rare, glomus tumours occur in the knee. Unlike the classic description of glomus tumours occurring in the fingers most typically in women <30 years of age, those that occur in the knee tend to do so in men >30 years, and many years of pain can precede diagnosis. The astute radiologist may be the first to suggest this diagnosis if a small, painful, enhancing, nodular subcutaneous mass is noted on knee MRI examinations.
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Affiliation(s)
- G S Stacy
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, MC2026, Chicago, IL 60637, USA.
| | - N A Cipriani
- Department of Pathology, The University of Chicago, 5841 South Maryland Avenue, MC6101, Chicago, IL 60637, USA
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Wang Y, Li T, Lv Z, Bian Y, Feng B, Liu Y, Zhou X, Weng X. Glomus tumors around or in the knee: a case report and literature review. BMC Surg 2022; 22:97. [PMID: 35296290 PMCID: PMC8925242 DOI: 10.1186/s12893-022-01545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 03/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Glomus tumors commonly affect the extremities, especially subungual. And glomus tumors rarely occur around knee, which are often misdiagnosed. A lack of experience with glomus tumors is likely the cause. CASE PRESENTATION A 42-year-old female presented with continuous dull pain of right knee for the past 7 years. Severe pain was experienced after walking a few hundred meters or climbing up or down stairs. The patient had a slight limp, and the lateral superior aspect of her right knee was tender to palpation. The range of motion and skin around her right knee were normal. Magnetic resonance imaging revealed a well-defined abnormal lesion confluent with the periosteum on the femoral lateral supracondylar. She was finally diagnosed with glomus tumor according to pathological results. After surgery, the pain disappeared, and the patient was discharged three days postoperatively. At the 18-month follow-up visit, the patient reported sustained pain relief, and regular follow-ups were continued. Additionally, 30 published reports documenting 36 cases of glomus tumors around the knee were reviewed, which showed that 20% of all reported cases of glomus tumor around the knee had a history of trauma. The median age for male with glomus tumor was greater than that of female; however, the median duration of illness between the two groups was equivalent. The mean diameters of glomus tumors ranged from 4 to 65 mm, and locations around the knee included the knee joint cavity, soft tissue (e.g. popliteal fossa, patellar tendon, iliotibial band, and Hoffa's fat pad), distal femur, and proximal tibia. CONCLUSION Literature review demonstrated that no significant differences were found between male and female with glomus tumor in regard to location (left or right side) and illness duration. It was noting that a history of trauma may be a cause of glomus tumor and approximate 94.4% of glomus tumors was benign. The most effective therapy accepted for glomus tumors is complete surgical excision, and recurrence was rare after complete surgical excision.
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Affiliation(s)
- Yingjie Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, No. 169 Changle West Rd, Xi'an, 710032, China
| | - Zehui Lv
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China
| | - Yanyan Bian
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China
| | - Bin Feng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China
| | - Yong Liu
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China
| | - Xi Zhou
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China
| | - Xisheng Weng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China.
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Mani B, Priyadarshini A, Rajesh G, Sankarasubramanian A. Glomus tumor presenting as atypical tender papule on the lower limb. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2022. [DOI: 10.4103/jdds.jdds_58_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Berlinberg EJ, Markus DH, Jour G, Strauss EJ. Prepatellar Glomus Tumor of the Knee without an Identifiable Mass on MRI: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00025. [PMID: 33979812 DOI: 10.2106/jbjs.cc.19.00433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 71-year-old man presented with extreme anterior knee pain. His history, physical examination, and imaging were consistent with prepatellar bursitis, but his pain seemed out of proportion for these findings. The patient eventually underwent marginal excision of the inflamed prepatellar bursa which histopathology identified as a glomangioma. Postoperatively, he has complete resolution of his pain and has returned to his daily activities. CONCLUSION Glomus tumors are a rare cause of severe knee pain that completely resolves after excision. In the patient with extreme, localized knee sensitivity, it is important to consider this pathology even if no mass is identified on imaging.
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Affiliation(s)
- Elyse J Berlinberg
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York
| | - Danielle H Markus
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York
| | - George Jour
- Department of Pathology, NYU Langone Medical Center, New York, New York
| | - Eric J Strauss
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York
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Rahmani M, Iafrati MD, Naber SP. Glomangioma of the knee with no response to sclerotherapy. HUMAN PATHOLOGY: CASE REPORTS 2017. [DOI: 10.1016/j.ehpc.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Extradigital glomus tumor in the knee: excision with ultrasound guided needle localization. Skeletal Radiol 2015; 44:1689-93. [PMID: 26130071 DOI: 10.1007/s00256-015-2202-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/03/2015] [Accepted: 06/11/2015] [Indexed: 02/02/2023]
Abstract
Glomus tumors are rare neoplasms that are usually subungual in location, but can infrequently be found elsewhere in the body. When they occur in extradigital locations, they present a diagnostic challenge that may result in delay of definitive management. We report a case of a 51-year-old male who experienced decade long chronic pain because of a glomus tumor in the suprapatellar fat pad of the knee. This case is unique not only because of the glomus tumor's location, but also because it ultimately required ultrasound-guided needle localization for excision.
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Maxey ML, Houghton CC, Mastriani KS, Bell RM, Navarro FA, Afshari A. Large prepatellar glomangioma: A case report. Int J Surg Case Rep 2015; 14:80-4. [PMID: 26254119 PMCID: PMC4573405 DOI: 10.1016/j.ijscr.2015.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/29/2015] [Accepted: 07/04/2015] [Indexed: 11/04/2022] Open
Abstract
Large glomangioma appearing inrare, anteroinferior aspect of knee in healthy 49 year old male. MR imaging detected intermediate signal intensity on T1, mixed signal intensity on T2, and marked signal enhancement with gadolinium. Histology demonstrated large, dilated vessels surrounded by normal endothelial cells and infiltrating glomus cells which stained positively for smooth muscle actin.
Introduction Glomangiomas are rare, benign tumors derived from the glomus body, typically presenting with the classic triad of pain, tenderness to palpation, and hypersensitivity to cold. Most commonly they present as a solitary lesion in the extremities, especially subungual, but they may present elsewhere. Presentation of case We describe the case of a large (64 mm × 59 mm × 41 mm) glomangioma on the anteroinferior aspect of a healthy 49 year old male’s knee. Symptoms included constant throbbing pain with intermittent stabbing sensations localized to the mass. The mass was evaluated first by magnetic resonance (MR) imaging and then by histopathology following excision. Discussion Although rare, clinical diagnosis of glomangiomas may be sufficient in typical cases, however in atypical cases, like the one discussed here, further evaluation is often necessary. Here MR findings were suggestive of a glomangioma with low to intermediate signal strength on T1 and mixed signal strength on T2. Intravenous gadolinium infusion demonstrated marked heterogeneous enhancement of the lesion, as well as serpiginous vascular malformations surrounding the lesion. Histopathology following excision confirmed a benign glomangioma depicting monomorphic small, round eosinophilic cells with minimal atypia which stained positive for smooth muscle actin, and negative for cytokeratin, S-100 and CK-34 via immunohistochemistry. Conclusion The following case report details an atypical presentation of a benign glomangioma anterior to the knee in a patient experiencing chronic minor trauma to the area. Diagnosis was suggested by clinical presentation and MR imaging, and was confirmed histologically.
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Affiliation(s)
- Melissa L Maxey
- Department of Surgery, University of South Carolina School of Medicine, Two Medical Park Rd, Suite 300 General Surgery and Vascular Surgery, Columbia, SC 29203, United States.
| | - Chase C Houghton
- University of South Carolina School of Medicine, 6311 Garners Ferry Road, Columbia, SC 29209, United States.
| | - Katherine S Mastriani
- Department of Surgery, University of South Carolina School of Medicine, Two Medical Park Rd, Suite 300 General Surgery and Vascular Surgery, Columbia, SC 29203, United States.
| | - Richard M Bell
- Department of Surgery, University of South Carolina School of Medicine, Two Medical Park Rd, Suite 300 General Surgery and Vascular Surgery, Columbia, SC 29203, United States.
| | - Fernando A Navarro
- Department of Surgery, University of South Carolina School of Medicine, Two Medical Park Rd, Suite 300 General Surgery and Vascular Surgery, Columbia, SC 29203, United States.
| | - Ashkan Afshari
- Department of Surgery, University of South Carolina School of Medicine, Two Medical Park Rd, Suite 300 General Surgery and Vascular Surgery, Columbia, SC 29203, United States
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Gonçalves R, Lopes A, Júlio C, Durão C, de Mello RA. Knee glomangioma: a rare location for a glomus tumor. Rare Tumors 2014; 6:5588. [PMID: 25568752 PMCID: PMC4274446 DOI: 10.4081/rt.2014.5588] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/07/2014] [Accepted: 09/09/2014] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Ricardo Gonçalves
- Department of Orthopedic Surgery, Hospital Vila Franca de Xira, , Porto
| | - Ana Lopes
- Department of Orthopedic Surgery, Hospital Vila Franca de Xira, , Porto
| | - Clara Júlio
- Department of Orthopedic Surgery, Hospital Vila Franca de Xira, , Porto
| | - Carlos Durão
- Department of Orthopedic Surgery, Hospital Vila Franca de Xira, , Porto
| | - Ramon Andrade de Mello
- Department of Medical Oncology, Instituto Português de Oncologia Francisco Gentil, Porto
- Department of Biomedical Science and Medicine, Medical School, University of Algarve, Faro, Portugal
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Davenport D, Colaco HB, Edwards MR. The 30-year wait for treatment of an acutely painful knee. BMJ Case Rep 2014; 2014:bcr-2014-206512. [PMID: 25267810 DOI: 10.1136/bcr-2014-206512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 63-year-old retired man presented to our clinic reporting a severely painful, localised knee pain present for around 30 years and associated with a spontaneous palpable lump. He was prompted to seek medical advice at this point because his symptoms were exacerbated when his young grandchildren bumped into the knee. While radiographs were unhelpful, ultrasonography revealed a well-defined, subcutaneous soft tissue mass at the anterior aspect of the knee. Surgical excision was performed as a day case. Histological examination of the mass showed a glomus tumour. This patient had suffered for many years as a result of this painful mass but full resolution of his pain occurred immediately after excision.
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Affiliation(s)
- Dominic Davenport
- Department of Trauma and Orthopaedics, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Henry B Colaco
- Department of Trauma and Orthopaedics, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Max R Edwards
- Department of Trauma and Orthopaedics, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, UK
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Luis LR, Kaoru GR, Shemuel PB, Mills JL. Lower extremity glomus tumors: comprehensive review for surgeons. Vascular 2009; 16:326-32. [PMID: 19344590 DOI: 10.2310/6670.2008.00064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The diagnosis of a lower extremity glomus tumor (GT) is often delayed owing to the lack of awareness and low level of suspicion by the treating physician. GT is thought to arise from cutaneous arteriovenous connections, often involving the nail beds. The unusual location of the lower extremity often leads to missed or delayed diagnosis and management. Surgical excision of GT is often curative and provides significant symptomatic relief. There is a paucity of information in regard to GT in general, especially among vascular surgeons. The aim of this report is to make the surgical community more aware of this disease entity based on the analysis of our own experience and review of the literature.
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Affiliation(s)
- Leon R Luis
- Vascular Surgery Section, Southern Arizona Veteran Affairs Health Care System, Tuscon, AZ 85723, USA.
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Glomus tumor and knee pain: a report of four cases. Knee 2009; 16:231-4. [PMID: 19136262 DOI: 10.1016/j.knee.2008.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 11/12/2008] [Accepted: 11/15/2008] [Indexed: 02/02/2023]
Abstract
We present four cases of glomus tumors presenting as knee pain. All cases were treated by surgical excision of the tumor. All patients made an immediate recovery with return to full normal function. The presentation of this is unique in that the patient has exquisite pain and tenderness when the area affected is palpated. Occasionally, local infiltration or an ischaemia test can assist with diagnosis. To our knowledge, this is the largest case series in the literature.
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Schiefer TK, Parker WL, Anakwenze OA, Amadio PC, Inwards CY, Spinner RJ. Extradigital glomus tumors: a 20-year experience. Mayo Clin Proc 2006; 81:1337-44. [PMID: 17036559 DOI: 10.4065/81.10.1337] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To review a large series of extradigital glomus tumors in order to gain a better understanding of their presentation and provide guidelines to aid in their diagnosis and treatment. PATIENTS AND METHODS We performed a retrospective review of all extradigital glomus tumors seen at our institution during a 20-year period (1985-2005) to document the incidence of the classic triad of symptoms, the duration of symptoms, the contribution of imaging to making a definitive diagnosis, and the effectiveness of treatment. RESULTS Fifty-six different patients with extradigital glomus tumors presented as follows: glomus tumors in the hand (3), wrist (4), forearm (11), elbow (4), arm (4), shoulder (2), buttock (1), thigh (5), knee (10), leg (3), ankle (2), foot (2), back (1), nose (1), cheek (1), ear lobe (1), and trachea (1). Forty-eight patients presented with pain and localized tenderness, but only 1 patient presented with cold Intolerance. The average duration of symptoms was greater than 7 years, with most patients being evaluated previously and having their conditions misdiagnosed. Magnetic resonance imaging proved to be the most useful modality for localization of these lesions. Surgical resection was the definitive treatment and generally provided immediate and sustained pain relief. CONCLUSIONS Extradigital glomus tumors are not a rare subgroup of glomus tumors. Treatment outcomes are excellent, but misdiagnosis and delayed diagnosis are common. Improved guidelines regarding symptoms and diagnosis of these neoplasms may reduce the morbidity, ensuing chronic pain, and psychiatric consequences of delayed diagnosis or misdiagnosis.
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Le Bellec Y, Yelles F, Kapandji T, Silbermann-Hoffman O. Tumeur glomique de l'avant-bras : à propos d'un cas. ACTA ACUST UNITED AC 2005; 24:99-102. [PMID: 15861979 DOI: 10.1016/j.main.2005.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors report a case of a glomus tumor of the soft-tissues of the forearm in a 23 year old woman. The diagnosis was suspected on MRI, and confirmed by a biopsy. The result after surgical resection was excellent, just like other cases in the literature.
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Affiliation(s)
- Y Le Bellec
- Clinique de l'Yvette, centre SOS main, 43, route de Corbeil, 91160 Longjumeau, France.
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Okahashi K, Sugimoto K, Iwai M, Kaneko K, Samma M, Fujisawa Y, Takakura Y. Glomus tumor of the lateral aspect of the knee joint. Arch Orthop Trauma Surg 2004; 124:636-8. [PMID: 14747953 DOI: 10.1007/s00402-003-0632-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2003] [Indexed: 11/26/2022]
Abstract
BACKGROUND We report a rare case of glomus tumor that occurred in the lateral joint of the knee. A 54-year-old man was referred to us with a 3-year history of lateral pain in the left knee and the diagnosis of lateral meniscus injury. Physical examination revealed a small trigger point localized just on the lateral joint space. Magnetic resonance imaging (MRI) showed a very small round mass in the subcutaneous tissue at the level of the lateral joint space. TREATMENT Excisional biopsy was performed, and the histology was characteristic of a glomus tumor. The patient was asymptomatic immediately after the operation. At the 3-year follow-up after the operation, no recurrence was seen.
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Affiliation(s)
- Kohjirou Okahashi
- Department of Orthopaedic Surgery, Saiseikai Nara Hospital, 4-643 Hachijo, Nara-shi, 6308145 Nara, Japan.
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