Hereditary multiple glomus tumors involving the glans penis. A case report and review of the literature

Unusual Glomus Tumor of the Penis

INTRODUCTION

Glomus tumors are benign neoplasms commonly found in subungual regions of the extremities and rarely located in the penis. Misdiagnosis of glomus tumors is common; therefore, symptoms and clinical presentations should be reviewed.

OBJECTIVE

The primary objective of this review article is to emphasize the pathogenesis, pathology, clinical presentation, symptoms, diagnosis, and treatment methods of glomus tumors in order to better identify and manage the condition.

MATERIALS AND METHODS

Research was conducted using PubMed/Medline. The inclusion criteria required glomus tumor to be present on the penis.

RESULTS

Glomus tumors, which appear as symptomatic or asymptomatic lesions, are attributed to dispersion grouping of neoplastic or non-neoplastic lesions in a particular area.

CONCLUSION

Differential diagnosis of glomus tumors includes hemangiomas, neurofibromatosis, epithelial lesions, and spindle-cell lesions. Physical examination and histological findings should be used for diagnosis. Treatment options can be either conservative or invasive, in which the patient undergoes surgical excision.

Unusual lesions mimicking impingement syndrome in the shoulder joint - Think medially

Impingement syndrome is usually caused by irritation of the rotator cuff within the sub acromial space and this includes the coraco-acromial arch (Acromion and Coraco-acromial ligament), the acromio-clavicular joint and occasionally the coracoid. Iatrogenic causes such as sutures, pins, plates or wires left from previous surgery can cause similar symptoms. We present a series of four cases mimicking “classical” impingement symptoms/signs in which the causal pathology was identified outside the sub-acromial space. Magnetic Resonance Imaging (MRI) showed lesions that were present in the supra-spinatus fossa but were causing pressure effects on the sub-acromial space, namely - a ganglion cyst in one case, lipomata in two other cases, and a glomus tumour. A ganglion cyst and glomus tumour mimicking impingement syndrome is a rare reported case to our knowledge.

These are unusual causes that should be considered when investigating classical impingement syndrome and particularly those who may have failed to respond to decompression surgery. They highlight the potential value of looking beyond the sub-acromial space for causal lesions and in these cases, at a time when limited ultrasound investigation has become increasingly popular; MRI has clearly played an important and was essential in planning surgery as these lesions would not have been identified on USS. Even though the symptoms were classical.

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Impingement syndrome is defined as impingement of the rotator cuff by the anterior one-third of the acromion, 1.

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Iatrogenic causes such as sutures, can cause similar symptoms.

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Symptoms and signs of impingement may be present can originate outside the sub-acromial space.

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MRI scan remains an important imaging tool.

Long-term survival case of malignant glomus tumor mimicking "dumbbell-shaped" neurogenic tumor

PURPOSE

We report a very rare case of long-term survival case of malignant glomus tumor (MGT) without widespread metastasis.

STUDY PARTICIPANTS

Sixty-three-year-old woman who experienced multiple relapses over a 40-year period beginning with a scapular lesion since she was at age 21.

RESULTS

After four local recurrences, the patient underwent wide resection of the scapula at age 36. Thirteen years later, the patient had a neck tumor at the same side with the scapulectomy. The tumor was originated from the C6 spinal nerve and was resected. Twelve years after the surgery, the cervical tumor relapsed with myelopathy at age 61. The tumor infiltrated from the extraspinal canal to the intraspinal canal at the C5/C6 foramen and appeared as a dumbbell-like tumor. Furthermore, the local recurrence occurred 2 years after the operation at age 63. The tumors that were detected at age 36 and age 63 were confirmed to be histologically identical. Those were more than 2 cm in size and arose from a deep location. The basement membrane stained positively for collagen type IV and α-smooth muscle actin on immunohistochemistry. Based on these aspects, the tumor was diagnosed as an MGT.

CONCLUSIONS

This is the first case report of MGT which lesions at two time points were confirmed to have common histological features and which confirmed the long-term survival over a 40-year period.

Multiple glomangiomas involving the glans penis in pediatric patient

Glomus tumors, especially multiple ones, are uncommon skin and soft tissue neoplasms occasionally seen in various internal organs. Involvement of the external genital organs including penis is extremely rare, and until now, scarce cases have been reported in the available literature.

MATERIALS AND METHODS

A routine histologic and immunohistochemical staining for pan-muscle actin, α-smooth muscle actin, desmin, CD31, and CD34 was applied for diagnosis of the lesions.

RESULTS

Three soft, bluish, and tender tumors localized on the ventral aspect of the glans penis in a 9-year-old boy were found. Furthermore, 3 other lesions situated on the fingers and the plantar surface of the foot were later sequentially noted. Local excisions of all tumors were performed, and glomangiomas were diagnosed based on typical microscopic features as well as immunohistochemical findings, that is, positive immunoexpression for actin but negative for desmin, CD31, and CD34. No recurrence was noted during the 5-year follow-up.

CONCLUSIONS

On the basis of our experience, conservative surgical procedure is sufficient for penile glomus tumors. However, each patient should be carefully examined for possible extragenital lesions.

Malignant Glomus Tumor

Malignant glomus tumor (MGT) is a rare, recently described neoplasm that recapitulates the appearance of the modified smooth cells of the normal glomus body. We report a case of MGT of the hand of a 48-year-old woman. Magnetic resonance imaging (MRI) showed a 2.8-cm, well circumscribed, enhancing mass on the volar aspect of the thenar region of the right hand in immediate continuity with the ulnar artery and nerve. Computed tomography scan (CT-Scan) of the chest was normal. Histologic evaluation revealed a multilobular lesion with prominent branching capillary vasculature and perivascular arrangement of sheets of tumor cells. The tumor cells were round, relatively uniform in size with distinct cell borders and perinuclear cytoplasmic clearing. They were of intermediate to high nuclear grade and showed significant mitotic activity. A wide local excision with negative margins was performed. Multiple lung metastases were evident at 8-month follow-up. To date, forty-five cases of MGT of skin and soft issue have been reported in the literature. Twelve of the forty-five cases developed metastasis. In this report, we emphasize the differential diagnosis of MGT in the skin and deep soft tissue.

Glomus tumor of the glans penis

Glomus tumors of the penis are extremely rare. We report a patient with a solitary glomus tumor involving the penis. A 19-year-old man presented with a complaint of a recurrent painful penile mass. Resection of the lesion was performed. The pathologic diagnosis was glomus tumor of the glans penis. This case emphasizes the need for complete extirpation of the glomus tumor to avoid additional surgery.