Lower extremity glomus tumors: comprehensive review for surgeons

Outcomes Following Excision of Toe Glomus Tumors

BACKGROUND

Glomus tumors are uncommon tumors and their occurrence in the foot is even less common. Glomus tumors of the toes are often missed, causing delays in diagnosis and treatment. We report an ambispective observational study of glomus tumors of the toes that were treated at our institution.

METHODS

We reviewed the records of all the patients who underwent excision of toe glomus tumors in our department from January 2010 to September 2022. The follow-up data were collected from the outpatient records and by telephonic interview. Single Assessment Numeric Evaluation (SANE) score, Foot and Ankle Outcome Score (FAOS), and the Foot Function Index (FFI) were collected.

RESULTS

Out of all the patients treated for glomus tumors, we found that 7 patients had glomus tumors of the toes. Of the 7 patients, 6 were women and 1 was a male. The mean follow-up of our patients was 66.4 months (range, 7-109 months). Of the 7 patients, 1 presented with recurrent glomus tumor 30 months following the primary operation, for which she underwent excision again, after which she was symptom free. Another patient who developed recurrent symptoms on telephonic interview refused any further treatment. Among the 6 patients who were symptom-free at follow-up (including the patient who underwent excision for the recurrent tumor), the median SANE score, and FFI were 99.5 (IQR, 96-100) and 0.5 (IQR, 0-2) respectively. The mean FAOS was 96 (SD, 3.3).

CONCLUSION

Surgical excision of the subungual toe glomus tumors can be curative. Recurrence of toe glomus tumors was noted in 2 patients (29%), one of whom refused further surgery. Re-excision in the other patient resulted in complete resolution of symptoms.

LEVEL OF EVIDENCE

Level III, ambispective observational study.

Giant thigh glomus tumor of uncertain malignant potential: Case report with pathologic-radiologic correlation

INTRODUCTION

Glomus tumors (GT) are rare, benign tumors that arise from glomus bodies and usually develop in digital areas. Extradigital GT are exceptional and thigh location is infrequent.

CASE REPORT

We report a case of a GT of the thigh in a 79-year-old male patient that measured 9.5 cm in maximum size. The GT lay above the muscular fascia without infiltrating it. Internal hypervascularity was seen by spectral Doppler ultrasound. Magnetic resonance image showed a heterogeneous mass with hyperintense and hypointense components and internal lobes with liquid-liquid levels. Histopathology revealed a monotonous round-cell proliferation with central nuclei without atypia or mitotic figures, around small-caliber vessels. These cells expressed smooth muscle actin and pericellular collagen IV. GT of uncertain malignant potential was diagnosed. The mass was completely removed. The patient did not experience local relapse nor distant metastasis.

CONCLUSION

GT are rare soft tissue tumors whose diagnosis of unusual giant masses in uncommon locations may be delayed and misdiagnosed given the low suspicion.

Extradigital glomus tumour of the thigh causing 8 years of undiagnosed debilitating pain

A woman in her mid-50s was referred to a plastic surgeon with an 8-year history of undiagnosed, localised severe, reproducible pain of the right thigh. Treatment with oral and topical analgesics, corticosteroids, acupuncture and physiotherapy did not provide symptom relief. She was referred to multiple specialists over the preceding 8 years including chronic pain physicians, physiatry, orthopaedic surgery and plastic surgery. Investigations including sonographic and MRI eventually revealed a non-specific soft tissue abnormality in the area of tenderness, which was excised en bloc. Histopathology revealed an extradigital glomus tumour. The patient's symptoms immediately and permanently resolved postexcision.Physicians seeing patients suffering from undiagnosed focal, reproducible pain should consider extradigital glomus tumours in their differential diagnosis. Workup for extradigital glomus tumour includes focused sonographic or MRI over the area of pain. Additionally, local injection of an anaesthetic agent can be used to assist with diagnosis.

Glomus tumor-induced lower extremity pain: A case report

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Glomus tumor is a rare small benign perivascular tumor, which develops from the glomus body located in the reticular dermis.

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The pain caused by glomus tumor could be easily mistaken to lower extremity pain whether it is radiating, sciatic, or just a localized one.

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A localized thermoregulator subcutaneous tumor could generate paroxysmal pain and sensitivity to pressure which is feigned as chronic radiating pain.

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A thorough examination is the key to a proper diagnosis of uncommon locations of the tumor.

Introduction

Glomus tumor located in the lower limb could be easily mistaken as lower extremity pain whether it is radiating, sciatic, or just a localized one. This could lead to misdiagnosis and improper management.

Presentation of case

This case reported a 56-year-old man complaining of pain in his left thigh. The pain was characterized as sharp and sometimes radiated to the skin of the calf muscles region. There was no history of trauma. Physical examination of the left thigh region revealed a small and barely palpable deep subcutaneous mass. Ultrasound examination showed a 6 × 5.3 mm partly cystic subcutaneous mass in the posteromedial region of the left distal femur. Doppler USG showed that the blood flow in the cystic lesion originated from the medial genicular artery. Surgical tumor excision through the medial femoral approach exposed a 15 × 10 × 5 mm yellowish-white thin encapsulated subdermal tumor attached to the vascular wall. Histopathology examination resulted in a Glomus Tumor.

Discussion

Glomus tumor usually occurs in areas that are rich in glomus bodies. Thigh is not a specific location for glomus bodies. It presented as bluish small nodule that are sensitive to touch and temperature changes. Glomus tumors in the thigh region rarely recurs since they are solitary and encapsulated, making them easily recognizable from the surrounding tissue during the operation.

Conclusion

Meticulous history taking, physical examination, and imaging modalities are necessary to differentiate between tumor and non-tumor lesions in less common areas.

Glomus tumour

Glomus tumours are rare tumours accounting for only 1-5% of soft tissue tumours of the hand. They are described classically in the subungual region. We present the case of a 32-year-old woman with a late diagnosis of a glomus tumour that had caused her excruciating pain. Clinical examination was positive for Hildreth's sign and the Love test. Magnetic resonance imaging delineated the tumour, which was excised and confirmed histologically. This case highlights the continued delay in diagnosis of glomus tumours as well as the use of imaging in diagnosis and planning of surgery.

Glomus Tumors in the Foot: Case Series

Glomus tumors are painful, benign neoplasms that frequently are associated with delayed diagnosis. Commonly in the hand, they rarely present in the foot. The purpose of this case series is to characterize the clinical presentation, radiology, pathology, and surgical outcomes associated with foot glomus tumors. We reviewed our pathology database for patients with foot glomus tumors diagnosed between 1995 and 2013. Medical records including physician notes, pathology, and radiology were reviewed. Eleven patients had foot glomus tumors excised at our institution during the study period. The mean age was 45.4 (range = 28-60) years. One patient was lost to follow-up. Mean follow-up for the remaining 10 patients was 44.7 (range = 3-142) months. Ten tumors were located in the subungual region, while 1 was located in the plantar pulp of the distal phalanx. All patients presented with pain. Point tenderness, cold hypersensitivity, and nail abnormalities were variably documented but frequently present. Four patients had had prior surgery for an ingrown toenail prior to presentation at our institution. Six patients had preoperative magnetic resonance imaging studies, which were diagnostic of glomus tumor in all cases except one. Radiographs failed to provide diagnosis in all 8 patients for whom they were obtained. Postoperatively, all patients had complete symptom relief with no recurrences.In conclusion, this case series demonstrates that foot glomus tumors frequently present with classic symptoms including pain, point tenderness, and cold hypersensitivity. When clinically suspected, magnetic resonance imaging should be obtained. Marginal excision results in symptom relief and cure.

LEVEL OF EVIDENCE

Therapeutic, Level IV: Case series.