Glomus tumors with malignant features of the extremities: a case series

Malignant glomus tumor of jejunum with liver and peritoneum metastasis: a rare case report

Glomus tumors (GTs) are rare mesenchymal neoplasms that occur predominantly on the subungual region of the distal extremities and are rarely seen in visceral organs such as the gastrointestinal tract. Malignant glomus tumors (MGTs) is even more rare, comprising less than 1% of all GTs. We reported an 82-year-old female patient with MGTs of the jejunum, accompanied by metastases to the liver and peritoneum. The patient presented with a primary complaint of epigastric pain with nausea and acid reflux for two months. Computed tomography scan revealed a prominently enhanced, inhomogeneous-density mass in the jejunum, the nature of which-benign or malignant-could not initially be determined. Postoperative pathological diagnosis confirmed the lesion to be a jejunal MGT. Regrettably, the patient declined additional treatment, subsequently developing liver and peritoneal metastases one year later. She eventually died within 18 months of initial diagnosis. This report summarizes the clinical and histopathological features of jejunal MGTs with the aim of increasing awareness among clinicians and pathologists regarding this disease.

Rare presentation of a primary intraosseous glomus tumor in the humerus of a teenager

A glomus tumor is a benign mesenchymal tumor comprised of cells that resemble the perivascular modified smooth muscle cells of the glomus body. Glomus tumors typically appear in the superficial lesions of the soft tissue in the extremities, such as the subungual region. However, their occurrence in the bone is rare, with only about 30 cases reported to date. Half of these cases involved the distal phalanges of the fingers or toes, with only three reported cases involving the long bones. Here, we present the first case, a primary glomus tumor in the humerus of a 14-year-old female. An osteolytic and cystic lesion was detected after a pathological fracture occurred during exercise. Despite the tumor's large size, no pathological findings indicated malignancy. The fracture healed through conservative treatment, while the tumor was effectively managed with curettage. Appropriate medical care can be provided to patients by focusing on pathological findings.

Glomus Tumor of the Chest Wall With Metastases to Lung

Glomus tumors are typically benign, soft tissue neoplasms composed of thermoregulatory glomus bodies. The more common varieties, such as subungual, are treated surgically and typically have a very low mortality rate. Malignant glomus tumors are very rare, and their pathogenesis is poorly understood. As such, treatment options and prognosis are unclear. We present a 67-year-old female diagnosed with a chest wall glomus tumor with biopsy-proven metastases to her lungs. Her treatment course included neoadjuvant radiation therapy followed by immunotherapy with pembrolizumab. After completion of the initial radiation therapy, imaging showed disease regression. Interval imaging after seven months of immunotherapy showed the resolution of all lung nodules with no reported concerns for disease recurrence. Pembrolizumab was discontinued due to concerns for dermatologic and renal adverse events, and the patient continues to be monitored off therapy. The metastatic glomus tumor described in this case had several unique qualities, including its initial presentation on the chest wall as an aggressive lesion, as well as its spread to multiple locations in the lungs. Glomus tumors are not normally as aggressive as seen in this case, but the genetic profile with high tumor mutational burden allowed for guided treatment. Radiation is often used as neoadjuvant treatment in higher risk glomus tumors, but the addition of immunotherapy such as pembrolizumab represents a potential avenue to manage these patients when surgery is not an option. Malignant glomus tumors are exceptionally rare occurrences that, by nature of their rarity, require protocols or therapies that are not specifically designed for their treatment. The clinical course of these tumors is difficult to predict as most cases of metastatic spread have few examples from which to draw conclusions. This case provided encouraging results for treatment with radiation and, potentially, immunotherapy. Each instance of a malignant glomus tumor and its genetic profile should be closely examined and documented so that sufficient data can be accumulated to guide treatment for this rare cancer.

Low-grade malignancy glomus tumor of the abdominal wall: a case report and literature review

Glomus tumors are painful neoplasms arising from the glomus body (responsible for body temperature and blood pressure regulation) in the skin. Although mostly present in the interdigital areas, glomus tumors can arise elsewhere. The vast majority of them are benign. Rarely, malignant variants are reported and are associated with the potential for local infiltration and metastatic dissemination. The abdominal wall location of glomus tumors is extremely rare regardless of whether they present as benign or malignant. We present a case of a 58-year-old female patient with a low-grade malignancy infiltrative glomus tumor of the abdominal wall.

Diagnosis and surgical approach in treating glomus tumor distal phalanx left middle finger: A case report

INTRODUCTION AND IMPORTANCE

Glomus tumors are rare mesenchymal neoplasms. These tumors originate from the glomus bodies and are commonly found in the fingertips, especially in the subungual location. The cause of this tumor is unknown. Clinically, the symptoms are non-specific and often not identified on physical examination and radiologically accompanied by rare cases, making it difficult to diagnose a glomus tumor.

CASE PRESENTATION

Current report present a case of pain at the tip of the middle finger of the left hand in a woman for six years and worsening in the last two years. The patient has visited several doctors with analgesic therapy, but the complaints have not improved. A bluish nail was found on physical examination, and a clinical study with the Love's pin test and the Hildreth test had positive results. Radiographic examination showed destruction with cortical thinning of the medial aspect of the distal phalanx of the left middle finger, and MRI showed a lesion with an erosion of the distal middle finger. In this case, complete surgical excision and biopsy were performed using a transungual surgical approach. The sample was sent for microscopic examination, showing a glomus tumor.

CLINICAL DISCUSSION

Cases with clinical symptoms of intense paroxysmal pain, exquisite point tenderness, and sensitivity to cold allow a clinical diagnosis in 90 % of cases. On clinical examinations such as Love's pin test, Hildreth's test, cold sensitivity test, and trans-illumination test with positive results and confirmed by MRI or ultrasound, the diagnosis of glomus tumor can be established.

CONCLUSION

This case shows a glomus tumor in the distal phalanges of the middle finger of the left hand-diagnosis enforcement through detailed history taking and physical examination, confirmed by MRI and microscopic examination. Complete surgical excision is an effective treatment. In this case, using a transungual surgical approach based on preoperative MRI, the subungual lesion was found to provide the best exposure.

Dermatologic Manifestations of Neurofibromatosis Type 1 and Emerging Treatments

Neurofibromatosis type 1 (NF1) is an autosomal dominant tumor predisposition syndrome that increases one's risk for both benign and malignant tumors. NF1 affects every organ in the body, but the most distinctive symptoms that are often the most bothersome to patients are the cutaneous manifestations, which can be unsightly, cause pain or pruritus, and have limited therapeutic options. In an effort to increase awareness of lesser-known dermatologic associations and to promote multidisciplinary care, we conducted a narrative review to shed light on dermatologic associations of NF1 as well as emerging treatment options. Topics covered include cutaneous neurofibromas, plexiform neurofibromas, diffuse neurofibromas, distinct nodular lesions, malignant peripheral nerve sheath tumors, glomus tumors, juvenile xanthogranulomas, skin cancer, and cutaneous T-cell lymphoma.

Presentación atípica de tumor glómico en vía aérea: reporte de caso y revisión de literatura

Introducción. Los tumores glómicos provienen de los cuerpos glómicos, que son estructuras con función de termorregulación y se encuentran distribuidas por todo el cuerpo humano, principalmente a nivel distal de las extremidades, donde es común encontrar lesiones características, aunque hay reportes de casos que se presentaron como neoformación en localizaciones más inusuales. Su etiología aun es desconocida. No se sospechan en muchos pacientes y el diagnostico se realiza de manera incidental, por estudios imagenológicos o anatomopatológicos. Caso clínico. Paciente femenina de 66 años, con presencia de tumor glómico en vía aérea, diagnosticado por histopatología e inmunohistoquímica, que fue sometido a resección quirúrgica, con buena evolución posterior. Discusión. Esta presentación atípica de tumor glómico en vía aérea se manifiesta principalmente con síntomas y signos relacionados con obstrucción de la vía aérea. El manejo oportuno es primordial y el diagnóstico definitivo es por histopatología e inmunohistoquímica, donde se observan las características de las células glómicas, estructuras vasculares, músculo liso y la positividad en la inmunotinción de marcadores como actina del músculo liso, CD34, y actina específica del músculo, entre otras. Conclusión. Los tumores glómicos son neoformaciones benignas raras, con presentación más común en zonas distales. Su aparición depende de factores intrínsecos y extrínsecos de los pacientes. Su tasa de recidiva es muy baja en comparación de otros tumores.

A Malignant Glomus Tumor of the Liver Harboring MIR143-NOTCH2 Rearrangement: From Diagnosis to Management

A primary malignant glomus tumor of the liver is extremely rare and diagnostically challenging. We present an exceptional case of such with a diagnosis confirmed by MIR143-NOTCH2 rearrangement. The case was successfully managed with neoadjuvant chemotherapy followed by surgery. This report highlights the utilization of molecular analysis to aid in the diagnosis of rare soft tissue malignancies and supports a multimodality approach to the treatment of large, high-grade malignant glomus tumors.

Total-Body Irradiation Is Associated With Increased Incidence of Mesenchymal Neoplasia in a Radiation Late Effects Cohort of Rhesus Macaques (Macaca mulatta)

PURPOSE

Cancer is a severe delayed effect of acute radiation exposure. Total-body irradiation has been associated with an increased risk of solid cancer and leukemia in Japanese atomic bomb survivors, and secondary malignancies, such as sarcoma, are a serious consequence of cancer radiation therapy. The radiation late effects cohort (RLEC) of rhesus macaques (Macaca mulatta) is a unique resource of more than 200 animals for studying the long-term consequences of total-body irradiation in an animal model that closely resembles humans at the genetic and physiologic levels.

METHODS AND MATERIALS

Using clinical records, clinical imaging, histopathology, and immunohistochemistry, this retrospective study characterized the incidence of neoplasia in the RLEC.

RESULTS

Since 2007, 61 neoplasms in 44 of 239 irradiated animals were documented (18.4% of the irradiated population). Only 1 neoplasm was diagnosed among the 51 nonirradiated controls of the RLEC (2.0%). The most common malignancies in the RLEC were sarcomas (38.3% of diagnoses), which are rare neoplasms in nonirradiated macaques. The most common sarcomas included malignant nerve sheath tumors and malignant glomus tumors. Carcinomas were less common (19.7% of diagnoses), and consisted primarily of renal cell and hepatocellular carcinomas. Neoplasia occurred in most major body systems, with the skin and subcutis being the most common site (40%). RNA analysis showed similarities in transcriptional profiles between RLEC and human malignant nerve sheath tumors.

CONCLUSIONS

This study indicates that total-body irradiation is associated with an increased incidence of neoplasia years following irradiation, at more than double the incidence described in aging, nonirradiated animals, and promotes tumor histotypes that are rarely observed in nonirradiated, aging rhesus macaques.