A painless glomus tumor: a case report

Extradigital glomus tumor: A rare case report

INTRODUCTION AND IMPORTANCE

Glomus tumors are benign soft tissue tumors of the glomus body, most regularly found in the sublingual region of the digits, palms, and soles. Extra digital lesions are uncommon and might be difficult to diagnose.

CASE PRESENTATION

We report a rare case of a 38-year-old man who presented with a painful nodule on his right upper arm. A definite diagnosis was made by histopathological study. A complete surgical excision was performed to avoid recurrence.

CLINICAL DISCUSSION

Glomus tumors form less than 2 % of all soft tissue tumors. The tumor was first reported by Wood in 1812. It typically appears like a small blue-red solitary papule in the hand especially the digits, which are the most prevalent location for glomus tumors with an incidence rate of up to 75 %. The histopathology findings of glomus tumor, are three components: glomus cells, vasculature, and smooth muscle cells. The preferred method of treatment is total excision to prevent a recurrence.

CONCLUSION

Eventually, the glomus tumor is fairly a rare benign tumor that physicians should keep in mind as a deferential diagnosis when facing a subcutaneous nodule and don't rule out when the tumor is extradigital.

A Curious Case of Paroxysmal Painful Thumb: Glomus Tumor Re-visited

Glomus tumor is a rare and benign vascular hamartoma originating from the neuro-myo-arterial apparatus of the glomus body in the reticular dermis. Most commonly, it presents as a solitary subungual lesion which is often painful and triggered by changes in temperature and pressure on the affected digit. However, multiple glomus tumors both digitally and elsewhere on the body which may or may not be painful are also known to occur. Due to its cryptic location and varied presentation, there is an invariable delay in the diagnosis and management of this condition. We report a case of glomus tumor in a 28-year-old woman presenting with paroxysmal painful lesion over her right thumb for 5 years.

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.

Clinical and onychoscopic characteristics of subungual glomus tumor: a cross-sectional study

BACKGROUND

Subungual glomus tumor is a relatively uncommon entity with varied clinical presentations which may lead to diagnostic delays. Onychoscopy can be used as an evaluation tool in routine evaluation of glomus tumors.

OBJECTIVES AND METHODS

With an aim to characterize the onychoscopic features of subungual glomus tumors, we analyzed 15 cases presenting over 3 years, in this observational study. The clinical, onychoscopic, radiological, and operative findings in these patients were evaluated and correlated depending on the location and extent of the lesions.

RESULTS

All 15 patients (11 female and 4 male) had pain as the presenting symptom and fulfilled the classic triad of paroxysmal pain, cold sensitivity, and positive Love's pin test. Clinical nail plate findings included onycholysis, onychorrhexis with distal splitting, and onychoschizia, while nail bed and matrix findings included localized erythematous and bluish patches, longitudinal erythema, and altered lunula. Onychoscopy corroborated the clinical findings and revealed a more extensive area of involvement in five cases. Definitive onychoscopy findings included a localized structureless erythema interspersed with bluish and patchy whitish areas (five cases of nail bed and six nail matrix tumors) and a "candy-cane appearance" (six cases, all large and lobulated nail matrix tumors). MRI reported the tumor in 13 cases, while two nail matrix tumors were missed. Transungual excision revealed tumors larger in size than predicted by MRI. The presence of candy-cane appearance was consistent with lobulated matrix tumors.

CONCLUSION

Onychoscopy improves the intraoperative detection of location and extent of subungual glomus tumors. Nail bed and nail matrix glomus tumors can have distinctive onychoscopic features that may help in better surgical planning.

Ultrasound features of the subungual glomus tumor and squamous cell carcinomas

BACKGROUND

Nail tumors often pose a significant challenge for the clinician, as they are burdened by a high delay in diagnosis and paucity of clinical signs in the early stage. In most cases, the onset of pain or nail plate dystrophy leads to imaging investigations such as plain radiography, magnetic resonance imaging, and ultrasonography (US) when surgery is pending.

MATERIAL AND METHODS

A 2-year monocentric study evaluated the histologically confirmed cases of subungual glomus tumor (GT) and squamous cell carcinoma (SCC) with a pre-surgical US assessment, and reviewed their sonography features. A total of 7 digital GTs and 6 SCCs of the nail were collected.

RESULTS

GT and SCC are easily distinguishable on US. Compared to SCC, GT was positively associated with an ovoid shape, well-defined borders, bone cup-scalloping without cortical erosion, and a rich intralesional vascular pattern (P < 0.05). Vice versa, SCC was significantly correlated with irregular shape, ill-circumscribed margins, an infiltrative growth pattern with peripheral hypoechoic foci, posterior acoustic shadow, cortical erosion, and a highly vascular multipolar peripheral pattern (P < 0.05).

CONCLUSION

The rapid assessment of GT and SCC sonographic features may contribute to reduce diagnostic delay, expedite management, and decrease the risk of surgical relapse.