Glomus tumors: report on eleven cases and a review of the literature

Glomus Extradigital Tumor: A Case Report of an Extradigital Glomus Tumor on the Wrist and Comprehensive Review of Glomus Tumors

A glomus tumor is a neoplasm composed of cells from the glomus body which is a contractile neuromyoarterial structure that affects blood pressure and thermoregulation by altering cutaneous blood flow. This cutaneous tumor can be benign or rarely malignant, solitary or multiple, and digital or extradigital. A benign glomus tumor usually presents as a non-familial, solitary, and subungual lesion. Multiple glomus tumors are less common, may be autosomal dominantly inherited, and extradigital. In contrast to a digital glomus tumor that often occurs within the nailbed or fingertip pulp of a young woman, a glomus extradigital tumor (GET) typically appears on the extremity or trunk of an older man. The diagnosis of a glomus tumor may be suspected based on clinical evaluation; it classically presents with a clinical triad of symptoms which includes lesion-associated tenderness, pin-point pressure pain, and cold sensitivity. However, cold-induced exacerbation of pain is frequently absent in extradigital glomus tumors; this may contribute to a delay in establishing the diagnosis of a glomus tumor in these individuals. Radiographic studies can support the diagnosis, but tissue specimen examination is necessary to establish the diagnosis. Resolution of tumor-associated pain is usually achieved following the complete excision of the neoplasm. A woman with a glomus tumor located on her wrist is described; her painful tumor was not sensitive to cold and was misdiagnosed clinically as a possible foreign body reaction to either a wood splinter or glass shard. The diagnosis of an extradigital glomus tumor was established after a microscopic examination of the tissue specimen following an excisional biopsy using a 3-millimeter punch biopsy tool. The neoplasm-related pain ceased and did not recur after the tumor had been completely removed. In conclusion, a glomus tumor is included in the differential diagnosis of a painful cutaneous neoplasm; however, misdiagnosis and/or substantial delay in diagnosis may occur if the tumor is extradigital or it lacks cold sensitivity or both. Therefore, the clinician needs to entertain the possibility of an extradigital glomus tumor when evaluating a patient with a tender, temperature-insensitive skin lesion that is not located on the fingers or toes.

Unusual glomus tumor of the lower leg: A case report

BACKGROUND

Glomus tumors are rare neoplasms, usually found on the fingers or toes. Glomus tumours that occur in the lower leg are even rarer and is likely to be misdiagnosed or underdiagnosed. This article will document the diagnosis, treatment, and follow-up of a rare glomus tumor of the lower leg, which had been misdiagnosed for up to 15 years.

CASE SUMMARY

The patient was a A 36-year-old woman who had suffered from localized pain in her left lower leg for 15 years. After a complete physical examination, a glomus tumor on her lower leg was considered and removed surgically. The specimen was pathologically diagnosed as a glomus tumor. There was no relapse at a 4-year follow-up.

CONCLUSION

Correct diagnosis and complete removal of the glomus tumor is important.

Low-Grade Malignancy Glomus Tumor in a Setting of Multiple Glomus Tumors - Case Report

BACKGROUND:

Glomus tumors are rare neoplasms accounting for less than 2% of all soft tissue tumors but multiple lesions may be seen in up to 10% of the patients. Solitary glomus tumor (GT) most frequently appears as small nodule in specific locations such as subungual region or deep dermis. However, rarely these entities have been observed in extracutaneous locations such as the gastrointestinal, cardiovascular, respiratory tracts, and other visceral organs. A small fraction of the GTs may present as tumors of uncertain malignant potential or as malignant glomus tumors.

CASE PRESENTATION:

We report a patient with multiple glomus tumors on the time of diagnosis, which was histologically diagnosed as an atypical glomus tumor following resection of a tumor thrombus in the left renal vein, inferior vena cava trombus with intracardial extension, and mitral valve specimen. The intramuscular lesion from the thigh was diagnosed as a glomus tumor of uncertain malignant potential. Further examinations revealed multiple lesions trough her body: kidneys, breast, heart and subcutaneous tissue. The diagnosis of glomus tumor of uncertain malignant potential versus glomus tumor with low malignant potential could be quite challenging, and the clinical course may be as a determining factor for final diagnosis.

CONCLUSION:

To our knowledge, this is the only known case of glomus tumor with multiple organ involvement and aggressive biological behavior at presentation.

Glomuvenous Malformation of the Neck

The cells in glomus body regulate blood flow to the skin and play a role in temperature regulation. Glomuvenous malformations (GVMs), previously reported in literature as glomus tumors or glomangiomas, are usually present in the nail bed. In 1972, Carroll and Berman described the triad of paroxysmal stabbing pain, point tenderness, and cold hypersensitivity associated with these malformations. We present an unusual case of GVM in the neck of a 17-year-old female presenting with a painful right-sided neck mass. Physical examination revealed an approximately 2.5 × 2 cm right-sided tender neck mass; pain was exacerbated by probing with a pinhead. Computed tomography identified multiple rounded masses in the neck, with the delayed contrast filling. The patient underwent excisional biopsy of the lesion and samples were sent for histopathological examination. The histopathology report, along with the radiological findings and the clinical presentation, confirmed the diagnosis of GVM. The patient remained symptom-free on long-term follow-up. Despite absence of previous reports, GVM can occur in neck. Surgical excision can lead to complete resolution of symptoms.

Glomus cell tumour on the head of a cat

Case summary

A solitary, sessile, non-ulcerated, freely mobile cutaneous mass approximately 1 cm in diameter on the left temporal region of a 7-year-old neutered female cat was examined. A fine-needle aspirate and wedge biopsy were performed by the referring veterinary surgeon and indicated a neoplasm of uncertain cell lineage. On histopathological examination, the deep dermis contained a discrete, non-encapsulated and vascular neoplasm with morphological and immunophenotypical features typical of a glomus cell tumour. Neoplastic cells were immunopositive for vimentin, muscle actin and smooth muscle actin, and immunonegative for cytokeratin, S100, desmin and von Willebrand factor (factor VIII-related antigen).

Relevance and novel information

Glomus cell tumours arise from modified smooth muscle cells and are rare in animals, particularly cats. Specific immunohistochemistry is of fundamental importance in the correct diagnosis of these tumours and should be considered for masses when cytology and histology results are inconclusive or uncertain.

Tumores glómicos en el miembro superior. Revisión de la literatura e informe de 14 casos

Objetivo: Revisar los resultados del tratamiento quirúrgico de los tumores glómicos del miembro superior tratados en nuestro servicio de cirugía de la mano en los últimos 15 años y comparar con la bibliografía especializada los datos de una serie de 14 tumores operados.

Material y método: Se trataron 14 tumores glómicos en 14 pacientes: 7 hombres y 7 mujeres. La media de edad fue de 50,7 años (rango 31-70).

En todos los pacientes se anotó la zona de presentación del tumor, su aspecto macroscópico con registro fotográfico, la técnica quirúrgica y el resultado final, funcional y estético.

Resultados: En todos los pacientes se dieron presentaciones únicas y todos se curaron completamente con el tratamiento quirúrgico, pero en 2 hubo recidivas y uno de ellos debió operarse hasta 5 veces para erradicar el tumor completamente.

Conclusión: El tumor glómico, por su infrecuencia, es poco conocido fuera del ámbito de la cirugía de la mano y de la dermatología, de ahí la demora en el diagnóstico que padecen buena parte de los pacientes. Los de presentación extradigital no suelen sospecharse y su diagnóstico lo aporta el estudio anatomopatológico.

El tratamiento quirúrgico, consistente en la exéresis de la masa tumoral y el legrado de la cavidad ósea si la hay, es resolutivo en la mayor parte de los casos, si bien la tasa de recidivas es muy elevada, probablemente por haberse realizado una escisión incompleta.

La complicación más frecuente es de tipo estético, por deformidades de la uña en los tumores de presentación subungueal.

Improvement in quality of life after surgery for glomus tumors of the fingers

Glomus tumors are benign and rare tumors that develop through a neuro-myo-arterial glomus. Complete surgical excision of the tumor remains the standard intervention. Due to the difficulty of diagnosis, management is often late, resulting in poor quality of life. This study aimed to assess improvement in quality of life after surgery in patients with glomus tumors. We performed a retrospective study from 1992 to 2011 to analyze 23 glomus tumors of the upper limbs in 22 patients. Pain was systematically the predominant symptom. Quality of life and disability were assessed preoperatively and postoperatively using two questionnaires in 11 patients: the Medical Outcome Study Short Form (SF-36 French version) and the Cochin Hand Functional Disability Scale. An evaluation of the visual analog scale (VAS) completed the study. The average age of patients was 48 years with a sex ratio of 0.28. The location of the tumor was in the fingers in 20 (87%) cases. The average delay between onset of symptoms and surgery was 8.5 years. Patients consulted an average of 2.8 practitioners. The average preoperative VAS was 8.7, whereas it was 0.8 postoperatively. Eleven patients were evaluated using the assessment scales, a mean of 11 years after surgery. Pain disappeared in 10 patients (91% of cases). A limitation of physical effort before surgery was found in five (45%) patients, while one patient (9%) had such limitation for a long period after surgery (P=0.006). The improvement in fine motion was also significant (P=0.03). Surgery had a positive impact on the emotional life of three patients (27%). Discomfort arose in the social life of four (36%) patients before surgery vs. one (9%) after surgery. Glomus tumors are rarely diagnosed during the first visit, leading to misdiagnosis and deterioration in quality of life, a cause of chronic pain, and limitations in activity. The significant improvement in quality of life provided by surgery necessitates earlier diagnosis of this tumor.

Glomus tumor of the hallux. Review of the literature and report of two cases

A glomus tumor is a rare and benign vascular tumor. It can originate in multiple locations on the body, although it has most frequently been found in subungeal areas of the hand. This two cases report describes a glomus tumor of the hallux, including a recurrence and a review of the related literature. We believe this case study might be of interest due to the unusual location of this tumor.

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.

Short-scar surgical approach for the treatment of glomus tumor of the digit

BACKGROUND

A glomus tumor is a biologically benign neoplasm. The traditional surgical approach to treat this tumor boasts the lowest recurrence rates but may cause nail deformities.

OBJECTIVE

A short-scar surgical approach was applied, with the aim of preserving the aesthetics of the nail.

METHODS

Between January 1999 and January 2009, 25 patients who underwent surgery for a glomus tumor were included in the study. All patients underwent radical resection with three different surgical approaches based on the location of the tumor.

RESULTS

All patients who were operated on had complete regression of pain immediately after surgery and at postsurgery follow-ups.

CONCLUSION

The treatment of glomus tumors consists of surgical excision, which is successful if properly executed. Excision of sensitive afferent nervous fibers is a prerequisite to achieve regression of pain. A short-scar surgical approach ensures complete eradication of the tumor and preservation of nail aesthetics.

Diagnosis and management of glomus tumors of the hand

AIM AND BACKGROUND

Glomus tumors are hamartomas that account for 1% to 5% of all soft tissue tumors of the hand. These tumors are usually benign. However, malignant degeneration can sometimes occur. They are usually characterized clinically by paroxysmal pain. Herein, we present our experience with 8 patients diagnosed with glomus tumors treated within the past 10 years.

MATERIALS AND METHODS

Eight patients who were diagnosed with glomus tumor of the hand were treated. Excruciating pain upon palpating the tumor was present in all the patients. Imaging studies such as magnetic resonance imaging were obtained but were only marginally helpful in locating and defining the surface topography for tumor resection. Meticulous dissection in a bloodless field and use of an operating microscope from the start of the operation were used for complete removal.

RESULTS

Complete excision of the tumor with free margins was confirmed in all 8 cases. However, 1 of the patients had recurrence of the tumor, which presented 4 weeks postoperatively. No other recurrence was observed during the follow-up period (1 to 10 y). The postoperative course in all patients was uneventful except for deformed fingernail formation in 3 of the patients.

CONCLUSIONS

Glomus tumor is a rare disease; we encountered only 0.26% cases in our patients (3014 patients referring for hand surgery) during a 10-year period. Imaging studies are not very helpful. Preoperative marking of the maximum point of pain helps the surgeon somewhat to locate the tumor clinically. We believe that a bloodless operation field and magnification are essential prerequisites for successful surgery. We also note that pain alleviation and no pain recurrence 2 months after surgery clinically signify a cure. The possible development of permanent nail deformity should be anticipated and must be discussed with the patient preoperatively.

À propos d’une tumeur glomique de la jambe

Glomus tumor is an uncommon benign neuromyoarterial tumor. It most frequently involves the fingers, and only rarely involves other sites. The clinical, imaging and therapeutic considerations regarding a glomangioma of the leg in a 65-year-old-man are reviewed.

Glomus tumor of the thigh: confluent with the periosteum of the femur

True glomus tumor is rare. In the majority of cases it involves the hand, preferring the fingertips or nail beds. We report a patient with glomus tumor of the mid-thigh who presented with severe localized pain and limp. The imaging features are discussed and the English literature reviewed.

Popliteal glomangioma mimicking Baker's cyst in a 9-year-old child: an unusual location of a glomus tumor

Popliteal cysts (Baker's cyst) are very common conditions in children. However, in the differential diagnosis of popliteal cysts in childhood, glomus tumor is the most infrequent diagnosis. This is a relatively uncommon soft tissue tumor that can occur at any age and any anatomic site, with a predilection for the subungual region. In the reported series, extradigital glomangiomas involving the knee are located in the patellar ligament, quadriceps tendon, patellar fat pad, and popliteal fossa. In this study, I present a second case of glomus tumor located in the popliteal fossa and misdiagnosed as a Baker's cyst. I also review the "around-the-knee glomus tumors" that have been discussed in the literature to date.

Glomus tumour in the digit of a dog

The gross and microscopical features of a glomus tumour in the digit of a 9-year-old dog are described. The tumour consisted of a red nodule near the nail of the third digit of the right forelimb and appeared painful. The tumour cells, which had round to oval hyperchromatic nuclei and scant cytoplasm, were arranged in sheets around blood vessels, or in nests or duct-like structures. This pattern has not been described previously in canine glomus tumours. Mitotic figures were seen only occasionally. Tumour cells were strongly immunolabelled for vimentin and some expressed smooth-muscle actin and desmin. They were negative for cytokeratins, neuron-specific enolase and CD34. Silver impregnation (reticulin method) stained the reticulum around blood vessels, nests of tumour cells and duct-like structures, and a delicate reticulum was seen around each tumour cell. The morphological, immunohistochemical and histochemical patterns helped in the diagnosis of this glomus tumour.

CD34-positive glomus tumor: clinicopathologic and immunohistochemical analysis of six cases with myxoid stromal changes

BACKGROUND

Glomus tumors are benign, mainly superficially located perivascular neoplasms, composed of cytologically characteristic neoplastic cells staining immunohistochemically positive for vimentin and muscle actin, closely associated with often branching blood vessels.

METHODS

Six cases of glomus tumor were analysed histologically and immunohistochemically.

RESULTS

We report six cases of glomus tumor (three solid glomus tumors, two glomangiomas, one glomangiomyoma) arising on the fingers of adult patients (five female and one male patient; age range 35-65 years) that showed prominent myxoid stromal changes and immunohistochemically a coexpression of alpha-smooth muscle actin and CD34 by neoplastic cells.

CONCLUSIONS

Neoplastic cells in glomus tumor may show a coexpression of alpha-smooth muscle actin and CD34, an important finding regarding the differential diagnosis of these lesions and the relationship of perivascular neoplasms.