Glomus tumour

Endoscopy-assisted laparoscopic wedge-resection of gastric glomus tumor: A case report

INTRODUCTION

Glomus tumor is a pericytic mesenchymal neoplasm that most commonly occurs in the extremities. The occurrence in visceral organs is rare and is a differential diagnosis with other gastric submucosal tumors.

PRESENTATION OF CASE

A woman with epigastric pain underwent esophagogastroduodenoscopy (EGD) which revealed a gastric submucosal tumor. Endoscopic ultrasound with fine-needle aspiration allowed preoperative diagnosis of gastric glomus tumor. Intraoperative EGD-assisted laparoscopic segmental gastrectomy was successfully performed. The patient was discharged in the second postoperative day. There was no evidence of recurrence at 8 months of follow-up.

DISCUSSION

The stomach is a rare location for the glomus tumor, a neoplasm of the glomus body, which is a perivascular structure with thermoregulatory function. Preoperative diagnosis is challenging, and endoscopic ultrasound (EUS) is useful for both assessing malignancy-associated features and biopsy guiding. The treatment is surgical resection with attention to adequate oncological margins while preserving healthy gastric wall.

CONCLUSION

Immunohistochemical analysis of specimen obtained by EUS fine-needle allows accurate preoperative diagnosis and laparoscopic-endoscopic combined surgery allows good oncological and functional results.

Glomus Tumor of the Left Second Toe Distal Phalanx: A Case Report and Review of Literature

Introduction

Glomus tumors are rare, benign neoplasms that originate from glomus bodies. While usually occurring in the subungual regions of the fingers, glomus tumors are seldom found in the foot, although rare reports have been made of glomus tumors in the hallux and even fewer in the lesser toes. We describe a reported case of a glomus tumor occurring in the distal phalanx of the left second toe that was initially missed on imaging studies, resulting in delayed diagnosis and surgical treatment. To the best of our knowledge, this represents one of the first few cases of glomus tumor reported in the lesser toes.

Case Report

A 34-year-old Chinese female presented with pain in the left second toe occurring for several years. Initial assessment and radiological investigations came back negative for abnormalities, resulting in delayed treatment. Upon second opinion of the MRI scans, a 0.2 × 0.2 × 0.2 cm well-defined round enhancing high T2-weighted signal focus within the germinal matrix of the left second toe subungual region was found, suggestive of a glomus tumor. Surgical exploration was offered, which found a skin-colored lesion, which was resected using a transungual approach. The final histology of the excised mass showed perivascular proliferation of uniform cells which contained round to ovoid nucleus with small nucleolus and pale eosinophilic cytoplasm, confirming glomus tumor.

Conclusion

Glomus tumors are rarely found in the foot, with even fewer reports in the lesser toes. Their rare occurrence in these regions reduces diagnostic suspicion for these tumors, delaying diagnosis and treatment for patients. This case report highlights the difficulty in diagnosing glomus tumors, even with adequate radiological investigations, and showcases the need for careful scrutinization of imaging. As this presentation is extremely uncommon, we hope that this case report increases suspicion of glomus tumors as a differential diagnosis for toe pain to ensure early treatment and alleviation of symptoms for patients.

Glomus tumour: an institutional experience of 31 cases

BACKGROUND

Glomus tumour is an uncommon soft tissue tumour which commonly occurs in the distal extremities, particularly the subungual region of the finger. Due to its rarity, there is a paucity of literature concerning glomus tumour. Therefore, this paper aims to report a case series based on our institution's experience.

METHODS

A retrospective cross sectional study was performed in a single tertiary institution in Singapore. All patients diagnosed with glomus tumour confirmed on histology from January 2019 to October 2022 were included in the study. Patient demographics and clinical information (presenting signs and symptoms, tumour parameters and presence of recurrence) were retrieved from existing medical records.

RESULTS

A total of 31 cases of glomus tumour were diagnosed from January 2019 to October 2022, and the relevant demographics and clinical presentation were reported. Majority of glomus tumours occurred in the finger (61.3%). Pain was present in almost all the cases (96.8%), while a lump was visible in less than half (48.4%). An average of 44.0 months elapsed before patients were properly diagnosed and treated. There were no cases of recurrence despite involved margins in three cases.

CONCLUSION

Glomus tumour can be easily missed if clinicians do not have an index of suspicion for it, resulting in delayed treatment. Once diagnosed, glomus tumour can be treated with complete excision with good outcomes.

Unsuspected gastric glomus tumour

Gastric glomus tumours (GGTs) are rare predominantly benign, mesenchymal neoplasms that commonly arise from the muscularis or submucosa of the gastric antrum and account for <1% of gastrointestinal soft-tissue tumours. Historically, GGT has been difficult to diagnose preoperatively due to the lack of unique clinical, endoscopic and CT features. We present a case of an incidentally identified GGT in an asymptomatic man that was initially considered a neuroendocrine tumour (NET) by preoperative fine-needle aspiration biopsy with focal synaptophysin reactivity. An elective robotic distal gastrectomy and regional lymphadenectomy were performed. Postoperative review by pathology confirmed the diagnosis of GGT. GGTs should be considered by morphology as a differential diagnosis of gastric NET on cytology biopsy, especially if there is focal synaptophysin reactivity. Additional staining for SMA and BRAF, if atypical/malignant, can help with this distinction. Providers should be aware of the biological behaviour and treatment of GGTs.

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.

Gastric Glomus Tumor Diagnosed by Upper Endoscopy

Gastric glomus tumors (GGTs) are benign tumors that typically occur in the submucosa of the gastric wall. Glomus tumors typically occur in the subungual region of the finger and rarely manifest in the stomach. Diagnosis is challenging as these tumors lack specific clinical features, radiographic findings, and endoscopic findings. In prior cases, endoscopic ultrasound with fine-needle aspiration has been utilized to make a pre-operative diagnosis. In our case, pathology from general endoscopy was consistent with a GGT. Thus, our patient was accurately diagnosed by esophagogastroduodenoscopy (EGD) with conventional biopsy.

Clinical, histopathological and immunohistochemical features of glomus tumor of the nail bed

Purpose: Glomus tumors account for 1–4% of benign hand tumors. In 65% of cases, it is located in the nail bed. Its rarity makes misdiagnosis problems relatively common. Symptomatology is characterized by the hallmark symptomatic triad. Imaging investigations may guide the diagnosis, but the diagnosis is made by pathological examination doubled by immunohistochemical (IHC) markers. Patients, Materials and Methods: We studied a group of seven female patients, aged 28 to 56 years. Clinical examination revealed the presence of the characteristic symptomatic triad. Ultrasound imaging tests were performed. Results: Anatomopathological examination made a diagnosis of glomus tumor in all seven cases. IHC staining showed that tumor cells were positive for alpha-smooth muscle actin (α-SMA) and h-caldesmon in all seven cases and negative for cluster of differentiation 34 (CD34) in 72.14%. IHC stainings for p63, S100, cytokeratin (CK) AE1/AE3 were negative in all cases. The clinical diagnosis completed by ultrasonography was histopathologically confirmed in all cases. Conclusions: Although the glomus tumor is a rare lesion, we need to be familiar with it because a diagnostic delay also implies a treatment delay which will lead to amplified suffering and even real disability due to the high-intensity pain in these cases.

Combined laparoscopic-endoscopic approach for gastric glomus tumor: A case report

BACKGROUND

Gastric glomus tumor (GGT) is rare submucosal mesenchymal tumor that lacks specific clinical manifestations and is usually treated mainly by traditional surgical resection. This paper presents a case of a GGT, exhibited both intraluminally and extraluminally growth that was removed by laparoscopy-gastroscopy cooperative surgery.

CASE SUMMARY

A 52-year-old male presented with epigastric discomfort accompanied by a sense of fullness for 3 mo. Upper gastrointestinal endoscopy identified a submucosal lump located in the gastric antrum. Endoscopic ultrasonography identified a 2.4 cm × 1.8 cm lump located in the gastric antrum. It originated from the muscularis propria and exhibited both intraluminally and extraluminally growth, with hypoechoicity on the periphery, hyperechoicity in the middle, and unclear boundaries. Computed tomography showed nodular thickening of 3.0 cm × 2.2 cm in the gastric wall of the gastric antrum, and after enhancement, the lesion exhibited obvious enhancement We suspected that it was a gastrointestinal stromal tumor (glomus tumor and schwannoma were not excluded) and planned to perform laparoscopy-gastroscopy cooperative surgery. Immunohistochemical staining after the operation revealed that spinal muscular atrophy (+), h-caldesmon (+), cluster of differentiation 34 (CD34) (+), 2% Ki-67-positive rate, CD56, melanoma antigen, CD117, discovered on GIST-1, leukocyte common antigen, caudal type homeobox 2, cytokeratin, and S-100 were all negative. The tumor was finally diagnosed as a GGT.

CONCLUSION

GGTs are rare submucosal tumors of the stomach and should be considered in the differential diagnosis of gastric submucosal tumors. Laparoscopy-gastroscopy cooperative surgery is less invasive and more precise and could be an effective method for the treatment of GGTs.

Rare glomus tumor formation following trauma to the first digit

INTRODUCTION

Glomus tumors are rare and few cases are reported in the literature. They typically occur in females on the digits of the hands.

CASE PRESENTATION

We report a case of a 30 year-old woman who presented with a mass that developed on the distal tip of her right thumb after traumatic injury. Magnetic resonance imaging (MRI) was conducted and mass resection was performed. Histopathology confirmed that the mass was a glomus tumor.

CLINICAL DISCUSSION

Clinical presentations of glomus tumors are typically non-specific, mainly consisting of a small mass with chronic pain, with a lengthy time to diagnosis and potentially improper management. MRI is the preferred diagnostic step, followed by curative surgical excision and pathological confirmation.

CONCLUSION

Glomus tumors can cause significant discomfort for patients, and clinicians should be aware of the rare diagnosis when treating painful masses on the extremities, as surgical excision is often curative.

Updates on the Pathology and Management of Nail Unit Tumors and Dermatoses

Nail unit pathology is indispensable to reach an accurate diagnosis of nail tumors as well as inflammatory disorders. This review article provides an update from the most recently published studies on the pathology and management of nail unit tumors and inflammatory disorders. Recent findings of nail clipping histopathology are described first, followed by discussing recent data on the diagnosis and surgical management of several types of nail unit tumors, ending with discussing the recent discoveries in selected nail unit inflammatory disorders.

A Compendium of Specific Histopathological Bodies in Dermatology

The spectrum of histopathological variations of most of the Dermatological conditions is so wide and overlapping that even with our current vast knowledge of this discipline, it seems to be a tough task for clinicians as well as Dermatopathologists to arrive at a conclusive diagnosis in many cases. However, with the aid of special stains and advanced diagnostic techniques, some characteristic histopathologic features have been defined over the time, among which histopathological bodies or inclusion bodies serve as specific clues. With this perspective in view, an attempt has been made to collate and describe the well-known as well as the lesser-known histopathological bodies seen in various dermatological diseases. The underlying pathogenesis and ultramicroscopic features of these structures have also been outlined in brief.