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Falcone MO, Asmar G, Chassat R. Subungual glomus tumor. HAND SURGERY & REHABILITATION 2024; 43S:101607. [PMID: 37866479 DOI: 10.1016/j.hansur.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
Subungual glomus tumors arise from the glomus body of the digits. They are rare and benign and often in a single location. Their diagnosis relies on the typical clinical triad of symptoms and on imaging findings, mainly magnetic resonance imaging with gadolinium injection. Subungual tumors treatment is complete resection, essential for cure. The different surgical techniques aim to: a painless digit with normal range of motion and sensitivity, without nail deformity after tumour resection, and to recurrence prevention. They vary according to tumor location. Classic surgical approaches are: the nail unit sparing ones (para-ungual, lateral subperiosteal, periungual), and the nail unit non-sparing ones (all transungual approaches with nail bed splitting). In this paper, we review the literature for the different approaches describing the advantages and drawbacks of each of them. We also describe the author's preferred subperiosteal "shark mouth" flap containing the nail plate and the nail bed as a single unit. It can be performed whether the tumor is located centrally, peripherally, or under the germinal matrix with very satisfactory outcomes.
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Affiliation(s)
- Marc-Olivier Falcone
- Clinique Jouvenet, Capio - Ramsay Santé, 6 Square Jouvenet, 75016 Paris, France; Hôpital Privé Paul d'Egine, Capio - Ramsay Santé, 4 Avenue Marx Dormoy, 94500 Champigny sur Marne, France.
| | - Ghada Asmar
- Hôpital Privé Paul d'Egine, Capio - Ramsay Santé, 4 Avenue Marx Dormoy, 94500 Champigny sur Marne, France
| | - Romain Chassat
- Hôpital Privé de l'Ouest Parisien, Capio - Ramsay Santé, 14 Rue Castiglione Del Lago, 78190 Trappes, France
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2
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Sechi A, Starace M, Piraccini BM, Wortsman X. Ultrasound Features of Onychopapilloma at High-Frequency and Ultra-High Frequency. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:71-76. [PMID: 37750808 DOI: 10.1002/jum.16338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE This study aimed to identify the sonographic features of pathologically confirmed onychopapilloma cases. METHODS High-frequency up to 24 MHz and ultra-high frequency-ultrasound up to 71 MHz examinations were performed and correlated with their clinical and pathologic presentations. RESULTS Twenty-two cases met the criteria. Clinical presentations revealed longitudinal erythronychia in 63.3% of cases. The ultrasound examinations identified a hypoechoic band in the nail bed (86.3%), nail plate abnormalities including upward displacement (68.2%) and thickening (68.1%), focal hyperechoic focal spots on the nail plate (50%) and irregularities of the ventral plate (33.3%). Color Doppler imaging showed no hypervascularity of the nail bed in all studies. These findings correlate with histological characteristics of onychopapilloma, including nail bed acanthosis, papillomatosis, and layered hyperkeratosis. Recurrence occurred in two cases after surgery, with tumors showing proximal extension in the matrix region on ultrasound not evident during clinical examination. CONCLUSION High-frequency and ultra-high-frequency can provide anatomical information in onychopapilloma that could enhance understanding and management.
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Affiliation(s)
- Andrea Sechi
- Dermatology Unit, San Bortolo Hospital of Vicenza, Veneto, Italy
| | - Michela Starace
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S'Orsola, Bologna, Italy
| | - Bianca Maria Piraccini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S'Orsola, Bologna, Italy
| | - Ximena Wortsman
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
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3
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Wortsman X. Aplicaciones frecuentes de la ecotomografía Doppler color en dermatología que permiten ayudar al diagnóstico y manejo. REVISTA MÉDICA CLÍNICA LAS CONDES 2023. [DOI: 10.1016/j.rmclc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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4
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Fodor D, Rodriguez-Garcia SC, Cantisani V, Hammer HB, Hartung W, Klauser A, Martinoli C, Terslev L, Alfageme F, Bong D, Bueno A, Collado P, D'Agostino MA, de la Fuente J, Iohom G, Kessler J, Lenghel M, Malattia C, Mandl P, Mendoza-Cembranos D, Micu M, Möller I, Najm A, Özçakar L, Picasso R, Plagou A, Sala-Blanch X, Sconfienza LM, Serban O, Simoni P, Sudoł-Szopińska I, Tesch C, Todorov P, Uson J, Vlad V, Zaottini F, Bilous D, Gutiu R, Pelea M, Marian A, Naredo E. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:34-57. [PMID: 34479372 DOI: 10.1055/a-1562-1455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
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Abstract
Ultrasound has evolved in dermatology from an experimental phase to a daily practice imaging technique. Its several advantages include its safety, good balance between penetration and resolution, high definition, and the detection of blood flow in real time. Its applications are growing and include the support of the diagnosis and extent in all axes, including depth, vascularity patterns, staging, and follow up of multiple cutaneous diseases-benign cutaneous tumors, vascular anomalies, nail lesions, skin cancer, inflammatory cutaneous diseases, and aesthetics complications.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Departments of Dermatology, Universidad de Chile and Pontificia Universidad Catolica de Chile, Santiago, Chile.
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Tawfik EA, Gad A, Taeimah M, Gadallah N. Extradigital Glomus Tumor of the Forearm Identified During Neuromuscular Ultrasound: A Case Report. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/87564793211033240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Glomus tumors are rare benign soft tissue tumors that arise from the glomus body. They typically develop in the subungual region but may develop extradigitally anywhere, in the upper or lower limbs. Extradigital glomus tumors can be misdiagnosed for years because of their atypical position and presentation. Being aware of an extradigital glomus tumor is important because they can be encountered during imaging studies and may be the cause of the patient’s symptoms. This report presents a case of an extradigital glomus tumor, of the forearm, diagnosed during neuromuscular sonography, in a patient with chronic intractable neuropathic-like pain, along the medial side of the left forearm. Sonographic imaging of the nerves, muscles, and tendons did not reveal any abnormalities. However, meticulous imaging of all tissue layers detected a subcutaneous vascular nodule. Subsequent excision biopsy and histopathologic assessment revealed a glomus tumor. After surgery, the patient experienced dramatic relief of pain. This case report highlights the importance of careful sonographic examination of all the tissues, including skin and subcutaneous tissue layers, to avoid missing non-neuromuscular pathologies that impact patient’s management.
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Affiliation(s)
- Eman A. Tawfik
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Gad
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Taeimah
- Department of Anaesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Naglaa Gadallah
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Abstract
This review discusses, from a practical point of view, the most common imaging techniques and their applications in nail pathologies with some technical considerations. There are several imaging techniques for studying the nail, and all of them require proper devices and trained operators. The highest axial resolution and a more extensive range of applications are provided by ultrasound, which currently is the first-choice imaging technique for evaluating nail conditions. A correlation of state-of-the-art clinical and imaging figures supports the review of this topic.
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Chen L, Gao YH, Chen J, Yao YJ, Wang R, Yu Q, Hu B, Jiang LX. Diagnosis of Subungual Glomus Tumors with 18 MHz Ultrasound and CDFI. Sci Rep 2020; 10:17848. [PMID: 33082509 PMCID: PMC7575557 DOI: 10.1038/s41598-020-74774-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/30/2020] [Indexed: 01/08/2023] Open
Abstract
To evaluate the imaging features of subungual glomus tumors using 18 MHz high-frequency ultrasound with CDFI (Color Doppler Flow Imaging). 20 patients treated by surgical resection and examined by ultrasound between January 2008 and December 2019. All eligible cases are divided into two groups: Group A used the probe frequency of 9–14 MHz from January 2008 to December 2014, and Group B used the probe frequency of 18 MHz from January 2015 to December 2019. Patient demographics, clinical records, pathologic specimens and sonography features were reviewed. 50% of tumors in Group A and 100% of tumors in Group B showed clear boundary and regular shape. Blood flow signals were identified inside 50% tumors in Group A (3 in 6), all 14 cases with blood flow signals detected in Group B (14 in 14,100%). 2 cases were misdiagnosed and 1 case escaped diagnosis in Group A, no case was misdiagnosed in Group B. The accuracy of diagnosis rate of Group B is significantly higher than that of Group A. 18-MHz ultrasound combined with CDFI may be a practical useful tool for detecting subungual glomus tumors. More importantly 18-MHz ultrasound can obviously improve the diagnostic accuracy.
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Affiliation(s)
- Li Chen
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Yi-Hui Gao
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Jie Chen
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Yi-Jing Yao
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Rui Wang
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Qian Yu
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China.
| | - Li-Xin Jiang
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China.
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Sechi A, Alessandrini A, Patrizi A, Starace M, Caposiena Caro RD, Vara G, Brandi N, Golfieri R, Piraccini BM. Ultrasound features of the subungual glomus tumor and squamous cell carcinomas. Skin Res Technol 2020; 26:867-875. [PMID: 32585749 DOI: 10.1111/srt.12888] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/30/2020] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Andrea Sechi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Aurora Alessandrini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michela Starace
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Giulio Vara
- Radiology Unit, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Nicolò Brandi
- Radiology Unit, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Bianca Maria Piraccini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Surgical Resection of Occult Subungual Glomus Tumors: Cold Sensitivity and Sonographic Findings. Ann Plast Surg 2019; 81:411-415. [PMID: 29975235 DOI: 10.1097/sap.0000000000001555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We surgically treated subungual masses that were suspected glomus tumors, although definitive clinical and radiological findings were lacking. We report the outcomes of a retrospective case series. METHODS Of 42 patients treated by surgical resection between March 1996 and December 2015, 7 who met our inclusion/exclusion criteria were evaluated. At least 1 symptom of the typical triad (temperature sensitivity, severe pain, and localized tenderness) was absent, and computed tomography (CT) and magnetic resonance imaging (MRI) findings were normal. After ultrasonographic evaluation, we resected the masses using a transungual approach or a nail-preserving method. After pathological confirmation of the diagnosis, we followed all patients for at least 2 years to evaluate tumor recurrence and nail deformity. RESULTS In 5 patients, cold sensitivity was the only symptom; no physical finding was suggestive of a glomus tumor. Tenderness was evidenced by the 2 patients who lacked cold sensitivity. None of the 7 patients exhibited CT or MRI abnormalities, but small acoustic shadows were evident in 4 patients, and blood-rich nodules were noted in 2 patients. The mean diameter of the 7 tumors was 2.1 mm, and pathological examination revealed typical glomus bodies. No major surgery-associated complication developed during follow-up. The final mean visual analog scale score (assessing pain) improved to 0.3 from the mean preoperative value of 3.6. CONCLUSIONS Small glomus tumors exhibit few traditional symptoms and signs and no definitive radiological CT/MRI finding. However, cold sensitivity alone is a powerful surgical indication, and occasionally, ultrasonographic findings are useful even in the absence of CT/MRI findings.
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Mundada P, Becker M, Lenoir V, Stefanelli S, Rougemont AL, Beaulieu JY, Boudabbous S. High resolution MRI of nail tumors and tumor-like conditions. Eur J Radiol 2019; 112:93-105. [DOI: 10.1016/j.ejrad.2019.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/30/2018] [Accepted: 01/04/2019] [Indexed: 11/17/2022]
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Santoshi JA, Kori VK, Khurana U. Glomus tumor of the fingertips: A frequently missed diagnosis. J Family Med Prim Care 2019; 8:904-908. [PMID: 31041222 PMCID: PMC6482761 DOI: 10.4103/jfmpc.jfmpc_88_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Glomus tumors present as painful lesions, most commonly in the fingertips. These can present to outpatient clinics of multiple specialties. Materials and Methods: Retrospective review was performed of 37 patients diagnosed as having glomus tumor in the thumb or fingertips over a 10-year period. The data collected included demographics, presenting symptoms, duration, previous treatment history, physical examination, treatment, and recurrence. The data were presented by means of descriptive statistics. Results: The mean duration of symptoms before presentation was 3.8 years (range 2 to 12 years). The mean age at presentation was 38 years (range 16 to 62 years), and female to male ratio was 21:16. Twenty-two patients had left-hand involvement; thumb 8, index finger 5, middle finger 5, ring finger 14, and little finger 5. Clinical and radiological assessments were made preoperatively. At presentation, 18 cases had nail changes, whereas 19 had no obvious nail changes – out of these, 4 had pulp involvement. The lesion involved the subungual region in 33 cases. The mean size of the lesion was 3.8 mm (range 2 to 10 mm). Thirty-six patients were found to have histopathologically proven glomus tumors, whereas in one no specific lesion was found on histopathological examination; this patient returned with recurrence of symptoms at 2-month follow-up. There was no other patient experienced recurrence of symptoms. Conclusion: Early diagnosis of glomus tumors is important to avoid lengthy treatment delays, chronic pain, disuse syndromes, and psychiatric misdiagnoses.
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Affiliation(s)
- John Ashutosh Santoshi
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Vivek Kumar Kori
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Ujjawal Khurana
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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13
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Wortsman X. Sonography of Dermatologic Emergencies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1905-1914. [PMID: 28470978 DOI: 10.1002/jum.14211] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/05/2016] [Indexed: 06/07/2023]
Abstract
Dermatologic conditions may be the subjects of potential emergency consultations, and the knowledge of their sonographic appearance can facilitate an early diagnosis and management. In this pictorial essay, the sonographic dermatologic anatomy, technique, and conditions that can be supported by a prompt sonographic diagnosis are reviewed. The sonographic signs that may help diagnose these entities are discussed with a practical approach.
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Affiliation(s)
- Ximena Wortsman
- Departments of Imaging and Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Faculty of Medicine, University of Chile, Santiago, Chile
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14
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Lee TS, Wu HT, Chan RC, Wang JC. Sonographic diagnosis of a glomus tumor of the thigh. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:50-52. [PMID: 27444193 DOI: 10.1002/jcu.22381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
Extradigital glomus tumors are a very rare entity. Here, we report a rare case of a glomus tumor in an atypical anatomic site: the thigh. The clinical features together with the results of MRI, and sonography and Doppler sonographic imaging helped to distinguish glomus tumor of the thigh from other soft tissue neoplasms. The tumor arising from the thigh was excised, and following surgery, the patient was symptom free without evidence of complications or recurrence. There have only been a few previously reported cases describing the use of Doppler sonography in the evaluation of extradigital glomus tumors. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:50-52, 2017.
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Affiliation(s)
- Tzu-Shiuan Lee
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hung-Ta Wu
- Department of Radiology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Beitou District, Taipei 112, Taipei, Taiwan, ROC
| | - Rai-Chi Chan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Catalano O, Alfageme Roldän F, Solivetti FM, Scotto di Santolo M, Bouer M, Wortsman X. Color Doppler Sonography of Extradigital Glomus Tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:231-238. [PMID: 27914173 DOI: 10.7863/ultra.16.03023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/12/2016] [Indexed: 06/06/2023]
Abstract
We retrospectively collected cases of surgically proven extradigital glomus tumor (EDGT) and reviewed their demographic, clinical, and sonography features. A total of 18 single, subcutaneous EDGTs were gathered. All but one were located in the extremities. EDGTs typically appear as a small, hypoechoic, homogeneous, or slightly inhomogeneous, well-delimited nodule, disposed horizontally and painful under probe pressure. Intranodular vascularization is always present. Feeding artery and efferent vein are typical but inconstant findings.
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Affiliation(s)
- Orlando Catalano
- Department of Radiology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | | | | | | | | | - Ximena Wortsman
- Departments of Radiology and Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues Clinica Servet, University of Chile, Santiago, Chile
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Fan Z, Wu G, Ji B, Wang C, Luo S, Liu Y, Yuan J. Color Doppler ultrasound morphology of glomus tumors of the extremities. SPRINGERPLUS 2016; 5:1319. [PMID: 27563514 PMCID: PMC4980861 DOI: 10.1186/s40064-016-2883-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/20/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the value of color Doppler flow imaging (CDFI) in the diagnosis of glomus tumors in the extremities. METHODS Sonography results of 62 nodules of 50 patients with glomus tumors in the extremities confirmed by surgery and pathology were analyzed retrospectively. RESULTS The sex ratio in the group of 50 patients was (female:male) = 5.25:1. Glomus tumors were more common in women aged 30-40 years. 84 % (42/50) of glomus tumors occurred in the fingers, with the thumb being the most common. 2D results showed that 64.52 % (40/62) of 62 nodules were hypoechoic, 30.65 % (19/62) were heterogeneous echo, 4.84 % (3/62) were hyperechoic; 64.52 % (40/62) had a clear border, while 35.48 % (22/62) had an unclear border. CDFI showed that 38.71 % (24/62) had visible rich blood in the tumor, 35.48 % (22/62) had little visible blood in the tumor, and 25.81 % (16/62) had no significant intratumoral blood flow. Of the 50 patients, 92 % (46/50) showed a fixed contact pain, were sensitive to cold stimuli, which was improved by hot water and air, and for which anti-inflammatory treatment was ineffective. CONCLUSION Glomus tumors in the extremities had certain ultrasound features, and its internal blood flow was diverse. Understanding this feature may be helpful for the diagnosis of non-typical glomus tumors.
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Affiliation(s)
- Zhina Fan
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
| | - Gang Wu
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
| | - Bing Ji
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
| | - Cunfeng Wang
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
| | - Shuaiwei Luo
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
| | - Yinlong Liu
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
| | - Jianjun Yuan
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
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Cambise C, Del Tedesco F, Fernandez E, Coraci D, Santilli V, Padua L. Mammalian glomus tumor: Contribution of nerve ultrasound. Muscle Nerve 2016; 54:336-8. [PMID: 26788862 DOI: 10.1002/mus.25032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Chiara Cambise
- Institute of Neurology, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Filippo Del Tedesco
- Institute of Neurology, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Eduardo Fernandez
- Institute of Neurology, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Daniele Coraci
- Board of Physical Medicine and Rehabilitation, Department of Orthopaedic Science, "Sapienza" University, Rome, Italy.,Don Carlo Gnocchi Foundation, Milan, Italy
| | - Valter Santilli
- Board of Physical Medicine and Rehabilitation, Department of Orthopaedic Science, "Sapienza" University, Rome, Italy.,Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy
| | - Luca Padua
- Institute of Neurology, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Don Carlo Gnocchi Foundation, Milan, Italy
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Gómez-Sánchez M, Alfageme-Roldán F, Roustán-Gullón G, Segurado-Rodríguez M. The Usefulness of Ultrasound Imaging in Digital and Extradigital Glomus Tumors. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2014.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gómez-Sánchez M, Alfageme-Roldán F, Roustán-Gullón G, Segurado-Rodríguez M. Tumores glómicos digitales y extradigitales. Utilidad de la ecografía cutánea. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:e45-9. [DOI: 10.1016/j.ad.2014.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 01/12/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022] Open
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Kose D, Toy H, Gunel E, Caliskan U, Koksal Y. Coexistence of glomangioma and yolk sac tumour in a child: a case report. J Clin Diagn Res 2014; 8:QD01-2. [PMID: 24995227 DOI: 10.7860/jcdr/2014/7373.4324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 03/12/2014] [Indexed: 11/24/2022]
Abstract
Glomus tumours (GTs) primarily arise from glomus bodies that are located in the dermis layer of skin. However, they can be encountered ectopically in most parts of the body. As a result of researches done in a 17-month-old male patient who prssented to us with complaint of an increasingly growing swelling, he was diagnosed with a yolk sac tumour. Chemotherapy was started and then, he was operated. GT was found inside the tumoural mass. Our patient, who is the first case according to our knowledge, where the concurrence of yolk sac and glomus tumours was reported, has been discussed in the light of literature.
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Affiliation(s)
- Dogan Kose
- Faculty, Department of Paediatric Hematology and Oncology, Selcuk University , Konya, Turkey
| | - Hatice Toy
- Faculty, Department of Pathology, Necmettin Erbakan University , Konya, Turkey
| | - Engin Gunel
- Faculty, Department of Paediatric Surgery, Necmettin Erbakan University , Konya, Turkey
| | - Umran Caliskan
- Faculty, Department of Paediatric Hematology and Oncology, Necmettin Erbakan University , Konya, Turkey
| | - Yavuz Koksal
- Faculty, Department of Paediatric Hematology and Oncology, Selcuk University , Konya, Turkey
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Soto R, Aldunce MJ, Wortsman X, Sazunic I. Subungual schwannoma with clinical, sonographic, and histologic correlation. J Am Podiatr Med Assoc 2014; 104:302-4. [PMID: 24901593 DOI: 10.7547/0003-0538-104.3.302] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We show an unusual presentation of a schwannoma that was located in the ungual bed of the left great toe. The clinical, color Doppler ultrasound imaging, and histologic findings are shown to illustrate the case. This type of neurogenic tumor and the ultrasound presurgical imaging support should be considered when dealing with subungual tumors of the foot.
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Affiliation(s)
- Rosamary Soto
- Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Maria Jose Aldunce
- Department of Dermatology, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Ximena Wortsman
- Departments of Radiology and Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ivo Sazunic
- Department of Pathology, Dermopathology Section, Histodiagnostico Malaga, Faculty of Medicine, University of Chile, Santiago, Chile
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Wortsman X. Common applications of dermatologic sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:97-111. [PMID: 22215775 DOI: 10.7863/jum.2012.31.1.97] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In recent years, there has been growing use of sonography in the dermatologic field. Thus, this review analyzes the most common dermatologic applications of sonography with some technical considerations for performing this type of examination. Moreover, the sonographic findings in common benign and malignant skin tumors, inflammatory dermatologic diseases, and ungual and cosmetic conditions, among others, are considered. Thus, this noninvasive technique may be a potent adjunctive tool in the diagnosis and management of dermatologic conditions in daily practice, delivering critical information otherwise unavailable to the clinical naked eye.
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Affiliation(s)
- Ximena Wortsman
- Department of Radiology, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile.
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Wortsman X, Wortsman J, Guerrero R, Soto R, Baran R. Anatomical changes in retronychia and onychomadesis detected using ultrasound. Dermatol Surg 2010; 36:1615-20. [PMID: 20840496 DOI: 10.1111/j.1524-4725.2010.01694.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wortsman X, Merino D, Catalan V, Morales C, Baran R. Perineurioma of the nail on sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1379-1382. [PMID: 20733198 DOI: 10.7863/jum.2010.29.9.1379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Ximena Wortsman
- Department of Radiology, Clinica Servet, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
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Wortsman X, Wortsman J, Soto R, Saavedra T, Honeyman J, Sazunic I, Corredoira Y. Benign tumors and pseudotumors of the nail: a novel application of sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:803-816. [PMID: 20427793 DOI: 10.7863/jum.2010.29.5.803] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the scope of high-resolution sonography in the detection of benign tumors and pseudotumors of the nail unit. METHODS We performed a retrospective study of the sonographic findings in 103 consecutive patients with benign tumors and pseudotumors of the nail that were medically derived and confirmed histologically. Statistical analysis (Student t test) was performed comparing clinical and sonographic diagnoses. RESULTS Common benign tumors and pseudotumors of the nail can be detected on sonography, and they present different sonographic morphologic characteristics. According to origin, the lesions were considered ungual in 73% (n = 75) and periungual in 27% (n = 28) of the cases. Sonography showed their nature (solid or cystic), location, and extension as well as regional blood flow. In 35% of the cases, the use of sonography modified the clinical diagnosis, although the detailed anatomic information provided by sonography was useful in the planning of surgery in all cases. The addition of sonography was significant (P < .001) for the diagnosis of subungual exostosis and granulomas in comparison to clinical diagnosis. CONCLUSIONS Sonography is a noninvasive imaging method that can reliably detect common benign tumors and pseudotumors of the nail and provide precise data about their characteristics. This imaging modality can support diagnosis and surgery and can allow a better definition and improvement of the cosmetic outcome of the treatment.
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Abstract
Optical coherence tomography (OCT) is an emerging imaging technology based on light reflection. It provides real-time images with up to 2-mm penetration into the skin and a resolution of approximately 10 microm. It is routinely used in ophthalmology. The normal skin and its appendages have been studied, as have many diseases. The method can provide accurate measures of epidermal and nail changes in normal tissue. Skin cancer and other tumors, as well as inflammatory diseases, have been studied and good agreement found between OCT images and histopathological architecture. OCT also allows noninvasive monitoring of morphologic changes in skin diseases and may have a particular role in the monitoring of medical treatment of nonmelanoma skin cancer. The technology is however still evolving and continued technological development will necessitate an ongoing evaluation of its diagnostic accuracy. Several technical solutions are being pursued to further improve the quality of the images and the data provided, and OCT is being integrated in multimodal imaging devices that would potentially be able to provide a quantum leap to the imaging of skin in vivo.
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Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin. J Am Acad Dermatol 2009; 62:247-56. [PMID: 19962214 DOI: 10.1016/j.jaad.2009.06.016] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 05/22/2009] [Accepted: 06/01/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND High variable-frequency ultrasound is a recently available technique capable of clearly defining skin layers and deeper structures that also provides local perfusion patterns obtained in real time. OBJECTIVES The aim of the study was to assess the performance of variable-frequency ultrasound in the evaluation of skin lesions. METHODS We performed a retrospective study of 4338 skin ultrasound examinations in predominantly localized skin lesions, and in a group of 130 healthy controls. We determined ultrasound sensitivity, specificity, and statistical level of certainty, and compared ultrasound diagnoses with clinical diagnoses. RESULTS Referring diagnosis was correct in 73% of the lesions, and addition of ultrasound increased correctness to 97% (P < .001 for the difference). Ultrasound overall sensitivity was 99%, specificity was 100%, and statistical diagnostic certainty was 99% LIMITATIONS Ultrasound in its current version cannot detect lesions that are epidermal only or that measure less than 0.1 mm in depth. CONCLUSIONS Ultrasound is a reliable adjuvant for the accurate and precise diagnosis of skin lesions.
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