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Kransdorf MJ, Larsen BT, Fox MG, Murphey MD, Long JR. Musculoskeletal glomus tumor: a review of 218 lesions in 176 patients. Skeletal Radiol 2024:10.1007/s00256-024-04743-y. [PMID: 39078477 DOI: 10.1007/s00256-024-04743-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE To review the spectrum of clinical and imaging features of glomus tumor involving the musculoskeletal system including the typically solitary forms as well as the rarer multifocal forms (glomuvenous malformation and glomangiomatosis). MATERIALS AND METHODS A retrospective review of our institutional pathology database from 1996 to 2023 identified 176 patients with 218 confirmed glomus tumors. Primary imaging studies included MRI (125), radiographs (100), clinical/intraoperative photos (77), and ultrasound (36). Lesions were divided into two groups: those that are typically solitary involving specific anatomic areas (finger, toe, soft tissue, coccyx, and bone), and those that are multifocal (glomuvenous malformation and glomangiomatosis). RESULTS The finger was the most frequently involved anatomic location for the classic (sporadic) glomus tumor occurring in 51% of patients, 77% of which were women, with the nail plate involved in more of the 75% of cases. Sporadic lesions involving the skin, subcutaneous adipose tissue, and deep soft tissue were termed "soft tissue," and were identified in 39% of patients, 90% of which were in the extremities and in men in 81% of cases. The multifocal syndromic forms of glomus disease occurred in younger individuals and involved less than 6% of the study group. Patients with glomuvenous malformation presented early with predominantly cutaneous involvement, while those with glomangiomatosis present later, often with both superficial and deep involvement, and a high rate of local tumor recurrence. CONCLUSION While glomus tumor is generally uncommon, it frequently involves the musculoskeletal extremities. Knowledge of the spectrum of characteristic locations and appearances will facilitate definitive diagnosis.
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Affiliation(s)
- Mark J Kransdorf
- Department of Radiology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, USA.
| | - Brandon T Larsen
- Department of Pathology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, USA
| | - Michael G Fox
- Department of Radiology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, USA
| | - Mark D Murphey
- ACR Institute for Radiologic Pathology (AIRP), 1100 Wayne Avenue, Suite 1020, Silver Spring, MD, 20910, USA
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
- Department of Radiology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889, USA
| | - Jeremiah R Long
- Department of Radiology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, USA
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2
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Swift CA, Lebhar MS, Brown MI, Kirmse BM, Hoppe IC. Diaphragmatic Spasms: A Rare Presentation of a Glomangioma. Dermatol Surg 2024:00042728-990000000-00806. [PMID: 38754127 DOI: 10.1097/dss.0000000000004238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Clarice A Swift
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael S Lebhar
- Division of Plastic Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Madyson I Brown
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Brian M Kirmse
- Division of Pediatric Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ian C Hoppe
- Division of Plastic Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi
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3
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Takada T. Relationship between dermoscopic and histopathological findings of extradigital glomus tumors. Clin Case Rep 2024; 12:e8907. [PMID: 38770410 PMCID: PMC11103558 DOI: 10.1002/ccr3.8907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/08/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024] Open
Abstract
In extradigital glomus tumors, (1) noncontact and (2) contact dermoscopy show (1) a central purplish-white area corresponding to tumor nests surrounding enlarged vessels, a peripheral yellow-white area corresponding to mucin deposition, melanin granules, and fibrous tissue, and (2) white reticular and linear cord areas corresponding to pseudocapsules and collagen fibers.
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4
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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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5
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Al-Janabi MH, Abdallah G, Deeb H, Melhem F, Salloum R. Extradigital glomus tumor: A rare case report. Int J Surg Case Rep 2024; 116:109466. [PMID: 38442675 PMCID: PMC10926113 DOI: 10.1016/j.ijscr.2024.109466] [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: 01/29/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
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.
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Affiliation(s)
| | - Ghina Abdallah
- Faculty of Medicine, Tishreen University, Lattakia, Syria
| | - Hasan Deeb
- Faculty of Medicine, Tishreen University, Lattakia, Syria
| | - Firas Melhem
- Department of Plastic Surgery, Tishreen University Hospital, Lattakia, , Syria
| | - Rabab Salloum
- Department of Pathology, Tishreen University Hospital, Lattakia, Syria
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6
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Dhillon D, Hever P, Khandwala A. An exquisitely painful fingertip lesion. BMJ 2024; 384:e076208. [PMID: 38272499 DOI: 10.1136/bmj-2023-076208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
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7
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Lee WQ, Li Y, Yeo NEM. Glomus tumour: an institutional experience of 31 cases. J Orthop Surg Res 2023; 18:741. [PMID: 37777807 PMCID: PMC10541690 DOI: 10.1186/s13018-023-04234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023] Open
Abstract
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.
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Affiliation(s)
- Wen Qiang Lee
- Department of Orthopaedics, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Yihan Li
- Department of Anatomical Pathology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Nicholas Eng Meng Yeo
- Department of Orthopaedics, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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8
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Takanashi N, Asai S, Ogase Y, Fujii A, Atsumi H, Doi M, Kumaki N, Mabuchi T, Miyachi H. Ultrasonographic Characteristics in the Fingers and Other Superficial Glomus Tumours. Dermatol Res Pract 2023; 2023:7126799. [PMID: 37546347 PMCID: PMC10397493 DOI: 10.1155/2023/7126799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/04/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023] Open
Abstract
Glomus tumours are painful superficial tumours, and ultrasonography is an extremely useful and noninvasive diagnostic technique for superficial organs. In this study, we retrospectively examined glomus tumours using ultrasonography. Among 18 patients histopathologically diagnosed with glomus tumours via ultrasonography, we observed five different development sites: subungual areas or those surrounding the nail bed (12), other areas on the finger surface (3), abdominal wall (1), upper arm (1), and forearm (1). The ultrasonographic images revealed significant differences in tumour size, indicating that tumours on other body surfaces tended to be smaller than those on patients' fingers (p < 0.01). The depth/width ratios of tumours on the other body surfaces were significantly higher than those on the fingers (p < 0.05). The tumours showed a regular shape (72.2%) and clear border (100%). Furthermore, most tumours were low-echo tumours with a diameter of up to 15 mm, clear margins, and no lateral shadows. Abundant blood flow and vessels in and out of the tumours were also observed. In conclusion, our study describes the ultrasonographic characteristics of glomus tumours and reveals that they cannot be ruled out when diagnosing small painful subcutaneous tumours.
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Affiliation(s)
- Noboru Takanashi
- Department of Clinical Laboratory Technology, Tokai University Hospital, 143 Shimokasuya, Isehara, Kanagawa 259-1196, Japan
| | - Satomi Asai
- Department of Laboratory Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1196, Japan
| | - Yoko Ogase
- Department of Clinical Laboratory Technology, Tokai University Hospital, 143 Shimokasuya, Isehara, Kanagawa 259-1196, Japan
| | - Akiko Fujii
- Department of Clinical Laboratory Technology, Tokai University Hospital, 143 Shimokasuya, Isehara, Kanagawa 259-1196, Japan
| | - Haruyo Atsumi
- Department of Laboratory Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1196, Japan
| | - Mika Doi
- Department of Laboratory Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1196, Japan
| | - Nobue Kumaki
- Department of Pathology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1196, Japan
| | - Tomotaka Mabuchi
- Department of Dermatology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1196, Japan
| | - Hayato Miyachi
- Department of Laboratory Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1196, Japan
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9
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Cohen PR. Glomus Extradigital Tumor: A Case Report of an Extradigital Glomus Tumor on the Wrist and Comprehensive Review of Glomus Tumors. Cureus 2023; 15:e38737. [PMID: 37292537 PMCID: PMC10247156 DOI: 10.7759/cureus.38737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/10/2023] Open
Abstract
A glomus tumor is a neoplasm composed of cells from the glomus body which is a contractile neuromyoarterial structure that affects blood pressure and thermoregulation by altering cutaneous blood flow. This cutaneous tumor can be benign or rarely malignant, solitary or multiple, and digital or extradigital. A benign glomus tumor usually presents as a non-familial, solitary, and subungual lesion. Multiple glomus tumors are less common, may be autosomal dominantly inherited, and extradigital. In contrast to a digital glomus tumor that often occurs within the nailbed or fingertip pulp of a young woman, a glomus extradigital tumor (GET) typically appears on the extremity or trunk of an older man. The diagnosis of a glomus tumor may be suspected based on clinical evaluation; it classically presents with a clinical triad of symptoms which includes lesion-associated tenderness, pin-point pressure pain, and cold sensitivity. However, cold-induced exacerbation of pain is frequently absent in extradigital glomus tumors; this may contribute to a delay in establishing the diagnosis of a glomus tumor in these individuals. Radiographic studies can support the diagnosis, but tissue specimen examination is necessary to establish the diagnosis. Resolution of tumor-associated pain is usually achieved following the complete excision of the neoplasm. A woman with a glomus tumor located on her wrist is described; her painful tumor was not sensitive to cold and was misdiagnosed clinically as a possible foreign body reaction to either a wood splinter or glass shard. The diagnosis of an extradigital glomus tumor was established after a microscopic examination of the tissue specimen following an excisional biopsy using a 3-millimeter punch biopsy tool. The neoplasm-related pain ceased and did not recur after the tumor had been completely removed. In conclusion, a glomus tumor is included in the differential diagnosis of a painful cutaneous neoplasm; however, misdiagnosis and/or substantial delay in diagnosis may occur if the tumor is extradigital or it lacks cold sensitivity or both. Therefore, the clinician needs to entertain the possibility of an extradigital glomus tumor when evaluating a patient with a tender, temperature-insensitive skin lesion that is not located on the fingers or toes.
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Affiliation(s)
- Philip R Cohen
- Dermatology, University of California, Davis Medical Center, Sacramento, USA
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10
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Zironda A, Grotz TE, Folpe AL, Thiels CA. Gastrointestinal Glomus Tumors: A Single Institution, 20-Year Retrospective Study. J Surg Res 2023; 283:982-991. [PMID: 36915027 DOI: 10.1016/j.jss.2022.10.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/06/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Glomus tumors are rare mesenchymal neoplasms composed of cells resembling those of the thermoregulatory glomus body, typically occurring in the skin and superficial soft tissues. Rarely do they occur in the gastrointestinal tract, in particular the stomach, where they have been the subject of case reports and small series. We present our institutional experience with gastrointestinal glomus tumors. METHODS A retrospective review of all gastrointestinal glomus tumors was conducted across all three Mayo Clinic sites in Minnesota, Arizona, and Florida from 2001 to 2021. Patient characteristics, pathologic findings, imaging features, operative reports, and clinical outcomes were abstracted. Descriptive statistics were utilized to report outcomes. RESULTS Nine patients with glomus tumors were identified (five men and four women). The median age was 53 [interquartile range (IQR), 44-69] y. Four patients presented with abdominal discomfort, three had anemia or bleeding, and two tumors were incidentally diagnosed. Computed tomography scans identified masses thought to represent gastrointestinal stromal tumors or neuroendocrine tumors in all patients. The tumors were localized to the stomach in all cases, specifically in the gastric antrum. Seven patients underwent preoperative endoscopy, including five with endoscopic ultrasonography. Endoscopic biopsies were interpreted as glomus tumors (n = 3), neuroendocrine tumors (n = 2), and nondiagnostic (n = 2). All patients underwent open (n = 3) or minimally invasive (n = 6) margin-negative resection by wedge resection (n = 5) or distal gastrectomy (n = 4). No nodal metastases were identified radiographically or on pathologic examination. The median tumor size was 2.5 [IQR 1.3-3.4] cm. All tumors showed at least in part typical glomus tumor morphology and smooth muscle actin expression. Aberrant synaptophysin expression was present in the two tumors initially classified as NET. Using the current WHO criteria, tumors were classified as histologically malignant (n = 1) and of "uncertain malignant potential" (n = 8). At a median follow-up of 15 [IQR 1-56] mo, all patients were asymptomatic and without recurrence. Two patients died of unrelated causes. No patients received adjuvant therapies. CONCLUSIONS Our 20-year, single institution, 3-site experience with resected gastrointestinal glomus tumors suggests the rarity, predisposition to involve the gastric antrum, and potentially an indolent clinical behavior of many of these tumors. Long-term follow-up is warranted as some previously reported gastric glomus tumors have metastasized, including cases lacking morphologic evidence of malignancy. Surgical resection, with minimally invasive wedge resection alone, is likely sufficient for the management of most gastric glomus tumors.
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Affiliation(s)
- Andrea Zironda
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Travis E Grotz
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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11
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Pena-Burgos EM, Serra-Del Carpio G, Tapia-Viñe M, Ortiz-Cruz EJ, Pozo-Kreilinger JJ. Giant thigh glomus tumor of uncertain malignant potential: Case report with pathologic-radiologic correlation. J Cutan Pathol 2023; 50:390-395. [PMID: 36820733 DOI: 10.1111/cup.14416] [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: 12/13/2022] [Revised: 02/01/2023] [Accepted: 02/21/2023] [Indexed: 02/24/2023]
Abstract
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.
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Affiliation(s)
- E M Pena-Burgos
- Pathology Department, La Paz University Hospital, Madrid, Spain
| | | | - M Tapia-Viñe
- Radiology Department, La Paz University Hospital, Madrid, Spain
| | - E J Ortiz-Cruz
- Orthopaedic Surgery and Traumatology Department, La Paz University Hospital, Madrid, Spain
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12
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Xie Q, Xia Y, Zhang J, Zhu JM. A glomus tumor with intravascular spread and multiple metastases: A case report. Asian J Surg 2023; 46:1099-1100. [PMID: 35963682 DOI: 10.1016/j.asjsur.2022.07.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Qiang Xie
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yu Xia
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Jun Zhang
- Department of Obstetrics and Gynecology, Medical Center of Severe Cardiovascular of Beijing Anzhen Hospital, Beijing, 100029, China
| | - Jun-Ming Zhu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
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13
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Stacy GS, Cipriani NA. Glomus tumours of the knee: a case series. Clin Radiol 2023; 78:e123-e130. [PMID: 36333129 DOI: 10.1016/j.crad.2022.09.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 01/12/2023]
Abstract
AIM To review clinical and magnetic resonance imaging (MRI) features of patients with glomus tumour of the knee, and compare the present findings with cases from the English literature. MATERIALS AND METHODS The orthopaedic oncology and pathology databases at The University of Chicago were reviewed for cases of glomus tumour and small subcutaneous anterior knee masses. For all glomus tumours, the site of the tumour and age and sex of the patient were recorded. For those tumours arising in the knee, the symptom profile and MRI characteristics were recorded. The English literature was reviewed for cases describing glomus tumours in the knee. RESULTS Thirty-four patients with glomus tumour were recorded. Five glomus tumours occurred in the anterior knee, all in men aged ≥30 years, four of whom had a several-year history of pain prior to diagnosis. MRI showed small (<2 cm) nodular enhancing masses. Review of the English literature supports the anterior knee as a common location for lower-extremity glomus tumours, with a male predominance and several years of pain preceding diagnosis. CONCLUSION Although rare, glomus tumours occur in the knee. Unlike the classic description of glomus tumours occurring in the fingers most typically in women <30 years of age, those that occur in the knee tend to do so in men >30 years, and many years of pain can precede diagnosis. The astute radiologist may be the first to suggest this diagnosis if a small, painful, enhancing, nodular subcutaneous mass is noted on knee MRI examinations.
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Affiliation(s)
- G S Stacy
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, MC2026, Chicago, IL 60637, USA.
| | - N A Cipriani
- Department of Pathology, The University of Chicago, 5841 South Maryland Avenue, MC6101, Chicago, IL 60637, USA
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14
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Avery EC, Augustine H, Sade S, Dengler J. Extradigital glomus tumour of the thigh causing 8 years of undiagnosed debilitating pain. BMJ Case Rep 2022; 15:e249869. [PMID: 36535730 PMCID: PMC9764623 DOI: 10.1136/bcr-2022-249869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
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.
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Affiliation(s)
- Emma Claire Avery
- Plastic, Reconstructive and Aesthetic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Haley Augustine
- Plastic, Reconstructive and Aesthetic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Shachar Sade
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jana Dengler
- Plastic, Reconstructive and Aesthetic Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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15
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Extradigital Glomus Tumor of the Arm. Dermatol Surg 2022; 48:1119-1120. [PMID: 36037086 DOI: 10.1097/dss.0000000000003571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022]
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16
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Singal A, Bisherwal K, Agrawal S, Bhat S, Diwakar P. Clinico‐epidemiological
profile and management outcome of
subungual
digital glomus tumor—Indian experience. Dermatol Ther 2022; 35:e15745. [DOI: 10.1111/dth.15745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Archana Singal
- Department of Dermatology & STD University College of Medical Sciences & GTB Hospital (University of Delhi) Delhi India
| | - Kavita Bisherwal
- Department of Dermatology & STD University College of Medical Sciences & GTB Hospital (University of Delhi) Delhi India
| | - Sonia Agrawal
- Department of Dermatology & STD University College of Medical Sciences & GTB Hospital (University of Delhi) Delhi India
| | - Shuchi Bhat
- Department of Radiodiagnosis University College of Medical Sciences & GTB Hospital (University of Delhi) Delhi India
| | - Preeti Diwakar
- Department of Pathology University College of Medical Sciences & GTB Hospital (University of Delhi) Delhi India
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17
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Kwiecien GJ, Meaike J, Inwards CY, Rhee PC. Posttraumatic Glomus Tumor of the Digital Nerve with Atypical Presentation: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00003. [PMID: 35809023 DOI: 10.2106/jbjs.cc.22.00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 53-year-old man sustained an injury to his left index finger and underwent presumably traumatic neuroma excision from the radial digital nerve 2 years ago. He presented with a painful mass distal to the prior site of neuroma excision with distinctly different symptoms from those that led to his index surgery. Thus, he underwent excisional biopsy of the mass which was adherent to his radial digital nerve consistent with a benign glomus tumor on histologic examination. CONCLUSION Digital nerve glomus tumors are rare. In most of the cases, some portion of the digital nerve requires excision but decreased pain can be expected.
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Affiliation(s)
| | - Jesse Meaike
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Carrie Y Inwards
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Peter C Rhee
- Division of Hand Surgery, Mayo Clinic, Rochester, Minnesota
- Clinical Investigation Facility, Travis Air Force Base, California
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Glomus Tumor of the Lower Extremity Previously Misdiagnosed as Complex Regional Pain Syndrome in Close Proximity to a Myxofibrosarcoma: A Case Report. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202207000-00002. [PMID: 35797605 PMCID: PMC9263485 DOI: 10.5435/jaaosglobal-d-21-00311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
Abstract
Complex regional pain syndrome (CRPS) is a potentially devastating condition that can result in severe psychological and social morbidity. It is a diagnosis of exclusion, and other pathologic entities must be ruled out first. Glomus tumors are exquisitely painful benign vascular tumors that are most common in the hand and are rarely found in the lower extremity. Here, we present a case of a patient who developed a focus of severe anterior knee pain and tenderness a few months after a car accident that had been misdiagnosed as CRPS for 15 years. She coincidentally developed a sarcoma of her ipsilateral leg distal to this site. Magnetic resonance imaging of the sarcoma included the area of knee pain where, interestingly, it identified a separate small soft-tissue mass. A glomus tumor was diagnosed histologically in a needle biopsy specimen from this mass, which was resected along with the sarcoma. For the first time in 15 years, despite the additional sarcoma surgery, she reported relief of her pain and complete resolution of her “CRPS.”
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19
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Chien CPY, Lee VKH. Painful suprapatellar mass. Skeletal Radiol 2022; 51:1517-1520. [PMID: 34940896 DOI: 10.1007/s00256-021-03973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Carol Pui Yang Chien
- Department of Radiology, Queen Mary Hospital, H2, Main Block, Pokfulam, Hong Kong
| | - Victor Kam Ho Lee
- Imaging and Interventional Radiology Centre, CUHK Medical Centre, 9 Chak Cheung Street, Shatin, New Territories, Hong Kong.
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20
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Guedes GVC, Jácome DT, Alves GF, Monteiro AV. Epidemiological Analysis of Glomus Tumors of the Hand and Association with Recurrence Rate. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2022. [DOI: 10.1055/s-0042-1744466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Introduction Glomus tumors are benign, characterized by microvascular alteration, and mostly found in the subungual region of the hand. They are rare and associated with paroxysmal pain, tenderness on palpation, and thermal sensitivity. The aim of the present research was to analyze the epidemiology of glomus tumors and relate each of the variables with cases of recurrence.
Materials and Methods A retrospective review of medical records was undertaken in our hospital to collect epidemiological numerical variables (time between the onset of symptoms and diagnosis and surgery, age, size of the tumor on magnetic resonance imaging and the histopathological examination, time until recurrence and reoperation after surgery, duration of the follow-up) and categorical variables (gender, ethnicity, laterality, affected finger, location in the hand, surgical technique, smoking, preoperative symptoms, recurrence, and comorbidities). Then, we performed a statistical analysis to identify possible associations of the hand tumors with recurrences.
Results The review identified 66 patients with glomus tumors 52 of which were located in the hand. The mean age of the sample was 49 years, and it was mostly composed of white female patients. Pain was the main related symptom, and most tumors presented sizes between 5 mm and 1 cm. Among the 52 patients, 11 cases presented recurrences, with a mean time until onset of 39.4 months, but 3 of them were initially operated on at other hospitals. None of the variables was shown to be a predictor of recurrence, although we saw that bone involvement on radiographs was only present in certain cases of recurrence.
Conclusion The sample studied was large for this rare disease, and reinforced previous results regarding its epidemiology. As 54% of the cases of recurrence occurred at least twice, we think that genetic, histological and immunohistochemical analyses should be the focus of futures studies, as well as a search for bone and tendon involvement.
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Affiliation(s)
- Giovanni Vilardo Cerqueira Guedes
- Division of Hand Surgery, Department of Orthopedics and Traumatology, Instituto Nacional de Traumatologia e Ortopedia Jammil Haddad (INTO), Rio de Janeiro, RJ, Brazil
| | - Daniel Torres Jácome
- Division of Hand Surgery, Department of Orthopedics and Traumatology, Instituto Nacional de Traumatologia e Ortopedia Jammil Haddad (INTO), Rio de Janeiro, RJ, Brazil
| | - Gabriel Farias Alves
- Department of Orthopedics and Traumatology, Instituto Nacional de Traumatologia e Ortopedia Jammil Haddad (INTO), Rio de Janeiro, RJ, Brazil
| | - Anderson Vieira Monteiro
- Division of Hand Surgery, Department of Orthopedics and Traumatology, Instituto Nacional de Traumatologia e Ortopedia Jammil Haddad (INTO), Rio de Janeiro, RJ, Brazil
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21
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Kimura T, Kubota M, Hattori H, Saito M. Simultaneous Glomus Tumors of the Third and Fourth Toes: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00028. [PMID: 36099526 DOI: 10.2106/jbjs.cc.21.00780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A glomus tumor of the toes is rare, and as far as we know, there has been no report of simultaneous occurrence in 2 toes. A 45-year-old woman presented with forefoot pain. Based on imaging findings, glomus tumors of the third and fourth toes were suspected. Tumor resection was performed, and pathological examination confirmed the diagnosis of glomus tumors. CONCLUSION In this case, it was difficult to recognize the tumors because they occurred simultaneously in 2 toes. Even for sites where a glomus tumor is rare, it is important to understand the characteristic symptoms through a detailed interview and examination.
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Affiliation(s)
- Tadashi Kimura
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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22
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Wang Y, Li T, Lv Z, Bian Y, Feng B, Liu Y, Zhou X, Weng X. Glomus tumors around or in the knee: a case report and literature review. BMC Surg 2022; 22:97. [PMID: 35296290 PMCID: PMC8925242 DOI: 10.1186/s12893-022-01545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 03/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Glomus tumors commonly affect the extremities, especially subungual. And glomus tumors rarely occur around knee, which are often misdiagnosed. A lack of experience with glomus tumors is likely the cause. CASE PRESENTATION A 42-year-old female presented with continuous dull pain of right knee for the past 7 years. Severe pain was experienced after walking a few hundred meters or climbing up or down stairs. The patient had a slight limp, and the lateral superior aspect of her right knee was tender to palpation. The range of motion and skin around her right knee were normal. Magnetic resonance imaging revealed a well-defined abnormal lesion confluent with the periosteum on the femoral lateral supracondylar. She was finally diagnosed with glomus tumor according to pathological results. After surgery, the pain disappeared, and the patient was discharged three days postoperatively. At the 18-month follow-up visit, the patient reported sustained pain relief, and regular follow-ups were continued. Additionally, 30 published reports documenting 36 cases of glomus tumors around the knee were reviewed, which showed that 20% of all reported cases of glomus tumor around the knee had a history of trauma. The median age for male with glomus tumor was greater than that of female; however, the median duration of illness between the two groups was equivalent. The mean diameters of glomus tumors ranged from 4 to 65 mm, and locations around the knee included the knee joint cavity, soft tissue (e.g. popliteal fossa, patellar tendon, iliotibial band, and Hoffa's fat pad), distal femur, and proximal tibia. CONCLUSION Literature review demonstrated that no significant differences were found between male and female with glomus tumor in regard to location (left or right side) and illness duration. It was noting that a history of trauma may be a cause of glomus tumor and approximate 94.4% of glomus tumors was benign. The most effective therapy accepted for glomus tumors is complete surgical excision, and recurrence was rare after complete surgical excision.
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Affiliation(s)
- Yingjie Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, No. 169 Changle West Rd, Xi'an, 710032, China
| | - Zehui Lv
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China
| | - Yanyan Bian
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China
| | - Bin Feng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China
| | - Yong Liu
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China
| | - Xi Zhou
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China
| | - Xisheng Weng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Rd, Beijing, 100730, China.
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23
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Lee MW, Lee JY, Park SM. Solitary glomangioma on the chin: A rare case report. ORAL AND MAXILLOFACIAL SURGERY CASES 2022. [DOI: 10.1016/j.omsc.2022.100248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Alhroub OA, Mahameed SA, Abdelhafez MO, Alhroub A, Hour H, Hasasna N, Kamal N. A case of malignant glomus tumor (glomangiosarcoma) of the nasal cavity. J Surg Case Rep 2022; 2022:rjab641. [PMID: 35096369 PMCID: PMC8791658 DOI: 10.1093/jscr/rjab641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022] Open
Abstract
Glomus tumors are rare and usually benign. The malignant form (glomangiosarcoma) comprises <1% of all glomus tumors. There are limited reports that describe glomus tumors in the nasal cavity. However, to the best of our knowledge, glomangiosarcoma of the nasal cavity was never reported in humans. We report on the first case of nasal cavity glomangiosarcoma in a 59-year-old male who presented with a bleeding mass in his right nostril. We completely excised the lesion with a 0.7-mm free margin, and the histopathologic examination was consistent with glomangiosarcoma. A 6-month follow-up illustrated no evidence of recurrence or distant metastasis. Although it is rare, glomus tumors should be in the differential diagnosis of nasal cavity tumors. Histopathologic examination is essential for glomangiosarcoma diagnosis. Treatment requires complete excision with free margin, alongside careful clinical and radiological follow-up.
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Affiliation(s)
- Omar A Alhroub
- Correspondence address. Faculty of Medicine, Al- Quds University, Jerusalem, Palestine. Tel: 00972598963191; E-mail:
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25
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Göktay F, Güldiken G, Altan Ferhatoğlu Z, Güneş P, Atış G, Haneke E. The role of dermoscopy in the diagnosis of subungual glomus tumors. Int J Dermatol 2022; 61:826-832. [DOI: 10.1111/ijd.16042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/27/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Fatih Göktay
- Department of Dermatology Hamidiye Medical Faculty Haydarpaşa Numune Training and Research Hospital University of Health Sciences Turkey İstanbul Turkey
| | - Gaye Güldiken
- Department of Dermatology Hamidiye Medical Faculty Haydarpaşa Numune Training and Research Hospital University of Health Sciences Turkey İstanbul Turkey
| | - Zeynep Altan Ferhatoğlu
- Department of Dermatology Cerrahpaşa Medical Faculty İstanbul University‐Cerrahpaşa İstanbul Turkey
| | - Pembegül Güneş
- Department of Pathology Hamidiye Medical Faculty Haydarpaşa Numune Training and Research Hospital University of Health Sciences Turkey İstanbul Turkey
| | - Güldehan Atış
- Department of Dermatology Hamidiye Medical Faculty Haydarpaşa Numune Training and Research Hospital University of Health Sciences Turkey İstanbul Turkey
| | - Eckart Haneke
- Department of Dermatology Inselspital Bern University Hospital University of Bern Bern Switzerland
- Centro de Dermatología Epidermis Instituto CUF Porto Portugal
- Dermatology Practice Dermaticum Freiburg Germany
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26
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Mani B, Priyadarshini A, Rajesh G, Sankarasubramanian A. Glomus tumor presenting as atypical tender papule on the lower limb. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2022. [DOI: 10.4103/jdds.jdds_58_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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AlNuaim B, Binsulaiman N, Alkohlani A, Al-Ghannam A, AlMohsen Z, Al-Saati M. Diagnosis of glomus tumor of the elbow: A case report. Int J Surg Case Rep 2021; 90:106709. [PMID: 34953423 PMCID: PMC8715102 DOI: 10.1016/j.ijscr.2021.106709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Glomus tumors are rare and often benign vascular lesions that present classically in the subungual region of the hand. Nonetheless, presentations in atypical sites have been reported over the years. However, the classic symptoms of typical glomus tumors are often absent in tumors of atypical sites. CASE PRESENTATION We present a case of an extradigital glomus tumor with a 3-year history of pain in the lateral aspect of the elbow. DISCUSSION The case we present took three years and multiple visits to different clinics and specialties to reach the final diagnosis and management. It often takes longer to diagnose Glomus tumors of atypical sites and presentations. The causes could be related to the rare incidence, the atypical presentation in site and symptoms, or the diagnostic methods. CONCLUSION This case report discusses the possible causes behind the diagnostic delay in extradigital glomus tumors, aiming to raise clinical awareness among primary health care physicians.
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Affiliation(s)
- Bader AlNuaim
- Section of Orthopaedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital (KAAUH), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | | | - Abdullah Al-Ghannam
- Lifestyle and Health Sciences Research Center, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Zaid AlMohsen
- Section of Dermatology, Department of Medicine, Unaizah College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Maad Al-Saati
- Section of Orthopaedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital (KAAUH), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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28
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Floros T, Perivoliotis K, Samara A, Tsionga A, Ioannou M, Baloyiannis I, Tepetes K. Suprascapular glomus tumor: an unusual cause of chronic shoulder pain. Case Reports Plast Surg Hand Surg 2021; 9:22-25. [PMID: 34912941 PMCID: PMC8667895 DOI: 10.1080/23320885.2021.2014335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Glomus tumors (GT) are rare mesenchymal tumors that develop in the subungual digital region. Extradigital GTs are very rare, with atypical clinical features. We report the case of a 63-year-old male with a five-year history of intermittent shoulder pain, where an excisional biopsy confirmed the diagnosis of a glomus tumor.
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Affiliation(s)
- Theodoros Floros
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | | | - Athina Samara
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | | | - Maria Ioannou
- Department of Pathology, University Hospital of Larissa, Larissa, Greece
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29
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Ajala RT, Lyon KA, Lyon PR, Harris FS. Extradigital Glomus Tumor Mimics an Intrinsic Nerve Tumor in a Trauma Patient: Case Report and Literature Review. Cureus 2021; 13:e19256. [PMID: 34900456 PMCID: PMC8648149 DOI: 10.7759/cureus.19256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022] Open
Abstract
Glomus tumors are rare, painful, and usually benign neoplasms that typically occur at the subungual aspect of digits. Rarely, glomus tumors may arise in other areas of the body. We present a case of an extradigital glomus tumor on a forearm with prior trauma that presented with symptoms of an isolated peripheral neuropathy. Our review of literature reveals how upper or lower extremity glomus tumors can mimic neuropathies secondary to intrinsic nerve tumors (schwannoma, neurofibroma, or neuroma), radiculopathies, or manifestations of a complex regional pain syndrome (CRPS). We emphasize the need to consider a broad differential diagnosis that includes glomus tumor when evaluating patients with painful dermal masses producing peripheral neuropathy or radiculopathy signs owing to the infiltrative growth pattern into or mass effect exerted on nearby nerves.
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Affiliation(s)
- Rodiyah T Ajala
- Surgery, Texas A&M University College of Medicine, Bryan, USA.,Neurosurgery, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Kristopher A Lyon
- Neurosurgery, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Priscilla R Lyon
- Pathology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Frank S Harris
- Neurosurgery, Baylor Scott & White Medical Center - Temple, Temple, USA
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30
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Nguyen L, Kim BS, Besmens I, Pastor T, Vasella M, Huber N, Rebecchini C, Frueh FS, Calcagni M, Guidi M. An atypical localization of glomus tumor in the leg. Case Reports Plast Surg Hand Surg 2021. [DOI: 10.1080/23320885.2021.2003710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lynhda Nguyen
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Inga Besmens
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Tatjana Pastor
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Mauro Vasella
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nora Huber
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Caterina Rebecchini
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Florian S. Frueh
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Marco Guidi
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
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31
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Shen G, Wang R, Pan L, Kuang A. Axillary Glomus Tumor Revealed by FDG PET/CT. Clin Nucl Med 2021; 46:837-839. [PMID: 34028414 DOI: 10.1097/rlu.0000000000003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ABSTRACT Glomus tumors are vascular neoplasms arising from glomus bodies. They are typically found in tissues where glomus bodies are concentrated, including the subungual layer of the fingers or the deep dermis of the palm, wrist, forearm, and foot but rarely occur in the axillary region. Herein, we reported the MRI and FDG PET/CT findings of a glomus tumor presenting as an axillary mass in a 25-year-old woman.
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Affiliation(s)
- Guohua Shen
- From the Department of Nuclear Medicine, Laboratory of Clinical Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
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32
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Garcia LC, Fernandes ENDS, Sobreira NDP, Bittencourt FV. Extradigital glomus tumor: dermoscopic description and histopathological correlation. An Bras Dermatol 2021; 96:765-767. [PMID: 34563419 PMCID: PMC8790217 DOI: 10.1016/j.abd.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/17/2022] Open
Abstract
Glomus tumors are rare benign neoplasms arising from the neuromyoarterial structure called glomus body. They present as angiomatous papules, soft and painful, especially to cold and pressure. In general, they are solitary and affect the extremities, located mainly the subungual bed. Extradigital lesions are rare and can constitute a diagnostic challenge. This is the report of a patient with an extradigital lesion on the left arm, and its dermoscopic aspects, including angiomatous lagoons circumscribed by a pale halo, a structure not previously described in the two reports of extradigital glomus tumor with dermoscopic features, found in the literature.
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Affiliation(s)
- Lucas Campos Garcia
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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33
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Alyaseen HN, Al Ghadeer HA, Al-Ghanim ME, Aljawad HH, Cordoba CR. Extradigital Glomangioma of the Cutaneous Chest Wall. Cureus 2021; 13:e17910. [PMID: 34660105 PMCID: PMC8509110 DOI: 10.7759/cureus.17910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/09/2022] Open
Abstract
Glomus tumors (GTs) are rare benign tumors as a result of hyperplasia of glomus body. GT most commonly involves the subungual areas and rarely involves extra-digital sites. The clinical presentation of a glomus tumor is a triad of symptoms consisting of pain, cold intolerance, and pinpoint tenderness. Even though glomus tumors are benign, they can infrequently be malignant. Despite their benign nature, these lesions can cause disabling symptoms, therefore proper diagnosis and treatment is important. In this report, we present a 35-year-old Saudi male with a painful lesion on the right side of the chest wall at the posterior axillary line for seven years, with recent progressive growth and symptoms. Diagnosis of extra-digital glomangioma of the chest wall in this patient was confirmed by histopathology. The patient was managed by complete surgical excision of the lesion with the resolution of pain and without recurrence.
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Affiliation(s)
| | | | | | | | - Carlos R Cordoba
- Plastic Surgery, Montreal University Hospital Centre, Montreal, CAN
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34
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Kumar A, Wilke BK, Folpe AL, Murray PM. Glomangiomatosis of the Upper Extremity. J Hand Surg Am 2021; 46:716.e1-716.e3. [PMID: 33341297 DOI: 10.1016/j.jhsa.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023]
Abstract
We describe a 43-year-old woman with a 23-year history of recurrent extradigital glomus tumors (glomangiomatosis) of the hand and forearm. She presented with a typical presentation of pain, tenderness to palpation, and hypersensitivity of the affected regions. After surgical resection, she continued to present with new locations of tumor burden and progressively malignant features of the tumors. This exceedingly rare presentation highlights the importance of vigilantly monitoring patients for recurrence with glomangiomatosis.
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Affiliation(s)
- Arun Kumar
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
| | | | - Andrew L Folpe
- Division of Anatomic Pathology, Cancer Center, Mayo Clinic, Rochester, MN; Cancer Center, Mayo Clinic, Rochester, MN
| | - Peter M Murray
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL.
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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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Machboua A, Hamraoui S, Zarouki S, Kamaoui I, Alloubi I. [Posterior mediastinal glomangiomatosis: Exceptional location of a rare tumour]. Rev Mal Respir 2021; 38:848-852. [PMID: 34116882 DOI: 10.1016/j.rmr.2021.04.018] [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: 10/02/2020] [Accepted: 04/26/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Glomangiomatosis is a benign tumour proliferation which develops from the glomus cells in the wall of a vessel, and which contains abnormal venous capillaries. Its usual location is dermal at the extremities, mediastinal presentation is exceptional. OBSERVATION A 63-year-old patient, followed for scoliosis, was admitted for a spontaneous haemothorax. The CT scan found hypervascularized left paravertebral masses. Thoracoscopy with biopsy provided the diagnosis of a glomus tumour. Given that its diffuse nature makes surgical excision difficult and the risk of intraoperative bleeding very high, treatment with interleukin alpha 2 was proposed to the patient. After a 3-year course, we did not observe any evolutionary change in the lesions. CONCLUSION Glomangiomatosis is an insidiously evolving vascular tumour which must be considered in the presence of vascular lesions. The reference treatment is surgical excision when possible. On the other hand, hasty surgery in diffuse forms remains dangerous given the haemorrhagic nature of this tumour.
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Affiliation(s)
- A Machboua
- Service de chirurgie thoracique et cardiaque, C.H.U Mohamed VI, Oujda, Maroc.
| | - S Hamraoui
- Service de chirurgie thoracique et cardiaque, C.H.U Mohamed VI, Oujda, Maroc
| | - S Zarouki
- Service de chirurgie thoracique et cardiaque, C.H.U Mohamed VI, Oujda, Maroc
| | - I Kamaoui
- Service de radiologie, C.H.U Mohamed VI, Oujda, Maroc
| | - I Alloubi
- Service de chirurgie thoracique et cardiaque, C.H.U Mohamed VI, Oujda, Maroc
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Glomus Tumor: "A-Not-So-Rare" Cause of Chronic Shoulder Pain-A Case Report and Literature Review. Case Rep Orthop 2021; 2021:6666092. [PMID: 34136298 PMCID: PMC8175186 DOI: 10.1155/2021/6666092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/10/2021] [Indexed: 02/07/2023] Open
Abstract
Case A 61-year-old male presented with chronic shoulder pain resistant to conservative treatment. Imaging identified a nodular lesion in the deltoid muscle, which histology after resection identified as a glomus tumor. After surgery, the patient became asymptomatic and at 4-year follow-up has not shown signs of recurrence. Conclusion Glomus tumors around the shoulder should be considered when investigating chronic shoulder pain, as they are more common than thought. Despite being elusive, when diagnosed, excellent outcomes may be expected, with surgery resection being curative.
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Zanjani LO, Shafiee Nia B, Vosoughi F, Mirzaian E, Aghaghazvini L, Arabzadeh A. An unusual case of chest wall glomus tumor presenting with axillary pain: a case report and literature review. Eur J Med Res 2021; 26:49. [PMID: 34034818 PMCID: PMC8146208 DOI: 10.1186/s40001-021-00518-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/15/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Glomus tumor is an uncommon soft tissue tumor. However, as the tumor causes significant disability, its early diagnosis is essential. It involves subungual areas of fingers and toes in most cases, and its extra-digital involvement is rarely seen. To the best of the authors' knowledge, only a few chest wall involvement cases have been reported in the literature. CASE PRESENTATION In this paper, we describe a 63-year-old patient with a chest wall glomus tumor presenting with axillary paroxysmal pain and limitation in his shoulder range of motion that had been missed for nearly 15 years. His symptoms were relieved immediately following surgical excision. CONCLUSION Glomus tumors may involve any part of the human body. It is curable with surgical excision in most cases. Therefore, a correct early diagnosis has paramount importance. A high index of suspicion is needed for early diagnosis, especially when the tumor involves uncommon anatomic areas.
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Affiliation(s)
- Leila Oryadi Zanjani
- Orthopedic Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahman Shafiee Nia
- Orthopedic Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Vosoughi
- Joint Reconstruction Research Center, Orthopedic Surgery Department, End of Keshavarz Blvd, Imam Khomeini Hospital, Tehran University of Medical Sciences, 1419733141 Tehran, Iran
| | - Elham Mirzaian
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Aghaghazvini
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aidin Arabzadeh
- Joint Reconstruction Research Center, Orthopedic Surgery Department, End of Keshavarz Blvd, Imam Khomeini Hospital, Tehran University of Medical Sciences, 1419733141 Tehran, Iran
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Berlinberg EJ, Markus DH, Jour G, Strauss EJ. Prepatellar Glomus Tumor of the Knee without an Identifiable Mass on MRI: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00025. [PMID: 33979812 DOI: 10.2106/jbjs.cc.19.00433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 71-year-old man presented with extreme anterior knee pain. His history, physical examination, and imaging were consistent with prepatellar bursitis, but his pain seemed out of proportion for these findings. The patient eventually underwent marginal excision of the inflamed prepatellar bursa which histopathology identified as a glomangioma. Postoperatively, he has complete resolution of his pain and has returned to his daily activities. CONCLUSION Glomus tumors are a rare cause of severe knee pain that completely resolves after excision. In the patient with extreme, localized knee sensitivity, it is important to consider this pathology even if no mass is identified on imaging.
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Affiliation(s)
- Elyse J Berlinberg
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York
| | - Danielle H Markus
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York
| | - George Jour
- Department of Pathology, NYU Langone Medical Center, New York, New York
| | - Eric J Strauss
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York
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Li L, Bardsley V, Grainger A, Johnston P. Extradigital glomangiomyoma of the forearm mimicking peripheral nerve sheath tumour and thrombosed varicose vein. BMJ Case Rep 2021; 14:e241221. [PMID: 33846191 PMCID: PMC8048004 DOI: 10.1136/bcr-2020-241221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/03/2022] Open
Abstract
Extradigital glomus tumour is uncommon, little-known outside of its subungual location, and may present without its classic triad of tenderness, cold sensitivity and paroxysmal pain. Imaging is non-specific and diagnosis is often delayed, sometimes for years, leading to unnecessary morbidity. Surgical excision is the treatment of choice, although technique depends on case specifics. Histological subtypes depend on the relative prominence of glomus cells, vascular structures and smooth muscle. The vast majority of glomus tumours are benign. We highlight the importance of considering extradigital glomus tumours when generating differential diagnoses of an atypical painful lesion in a variety of clinical specialties.
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Affiliation(s)
- Lily Li
- Department of Trauma & Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | | | - Andrew Grainger
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - Phillip Johnston
- Department of Trauma & Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
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Çevik HB, Çiçek ÇA, Kayahan S, Gümüstas SA, Filinte GT. Glomus tumors of the upper extremity. HANDCHIR MIKROCHIR P 2021; 53:72-75. [PMID: 33588493 DOI: 10.1055/a-1333-2459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Glomus tumors are uncommon and painful benign perivascular neoplasms. They usually occur in the subungual region of phalanx, and present with a classic clinical triad of localized tenderness, cold hypersensitivity, and excruciating paroxysmal pain. The aim of this study was to review 45 cases of glomus tumor according to the clinical, radiological and therapeutic characteristics, and the clinical and functional outcomes of surgical treatment. MATERIALS AND METHODS A retrospective review was made of 45 glomus tumors of the upper extremity operated on between June 2005 and January 2019. Data were collected of demographic characteristics and the diagnostic, immunohistochemical, therapeutic and postoperative clinical findings. RESULTS The patients comprised 69 % females and 31 % males with a median age of 41 years at the time of surgery. The most commonly affected anatomic location was the digits (87 %). Of the 39 cases with an affected digit, there was a predominance of the middle finger in 28 % and the peri-subungual area in 51 %. There was no recurrence or need for secondary surgical intervention in any patient in this study. The mean QuickDASH score was 1.47 at mean 66 months follow-up. CONCLUSIONS Glomus tumor, which is usually seen in the middle finger of middle-aged women, presents with excruciating paroxysmal pain out of proportion to the tumor size. The long-term outcomes after surgical loupe-assisted surgery with a transungual approach were seen to be good, without local recurrence and an acceptable rate of postoperative nail dystrophy.
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Affiliation(s)
- Hüseyin Bilgehan Çevik
- Ankara Diskapi Yildirim Beyazit, Training and Research Hospital, Orthopaedics and Traumatology
| | - Çagla Amutkan Çiçek
- Istanbul Dr Lufti Kirdar Kartal Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery
| | - Sibel Kayahan
- Istanbul Dr Lufti Kirdar Kartal Training and Research Hospital, Pathology
| | - Seyit Ali Gümüstas
- Istanbul Dr Lufti Kirdar Kartal Training and Research Hospital, Orthopaedics and Traumatology
| | - Gaye Taylan Filinte
- Istanbul Dr Lufti Kirdar Kartal Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery
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Akechi Y, Miura S, Ochi M, Enoki M, Matsuda T, Kitazawa R, Fujibuchi T, Ochi H, Igase M, Ohyagi Y. Unilateral lower limb atrophy associated with glomus tumors: a case report. J Med Case Rep 2021; 15:8. [PMID: 33436045 PMCID: PMC7805226 DOI: 10.1186/s13256-020-02616-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Glomus tumors are soft tissue neoplasms comprised of glomus cells, vasculature, and smooth muscle cells, which occur commonly in a single subungual area of the digits, and their main clinical features include severe paroxysmal pain, localized tenderness, and cold hypersensitivity. Case presentation A 47-year-old Japanese man had suffered from chronic progressive paroxysmal shooting pain in his right leg since childhood. He avoided putting weight on his right foot whenever he walked. The frequency of paroxysmal pain and the number of tender points both gradually increased with age, and his right leg gradually atrophied. Magnetic resonance imaging of the lower extremity demonstrated multiple gadolinium-enhanced nodules that corresponded with his tender points. Excisional biopsy relieved his pain and provided a histopathological diagnosis of glomus tumors. Conclusion This case suggests that small glomus tumors located in deep tissue may cause disuse atrophy because of their long delay before diagnosis. Clinicians should consider the potential for glomus tumors when patients exhibit unilateral lower limb muscular atrophy with pain.
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Affiliation(s)
- Yuji Akechi
- Department of Neurology and Geriatric Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Shiroh Miura
- Department of Neurology and Geriatric Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Masayuki Ochi
- Department of Neurology and Geriatric Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Moe Enoki
- Department of Neurology and Geriatric Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takuya Matsuda
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Riko Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Taketsugu Fujibuchi
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Hirofumi Ochi
- Department of Neurology and Geriatric Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Michiya Igase
- Department of Neurology and Geriatric Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yasumasa Ohyagi
- Department of Neurology and Geriatric Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Smith DW. An Unusual Case of Periosteal Glomus Tumor at the Metacarpal Base Presenting as Type II CRPS: Case Report. Hand (N Y) 2021; 16:NP1-NP4. [PMID: 31984818 PMCID: PMC7818035 DOI: 10.1177/1558944719895618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: An unusual case involving a middle-aged male with a 9-year history of presumptive chronic regional pain syndrome (CRPS) and ulnar neuropathy was referred for failure in treatment. Methods: On presentation, the patient was requesting an amputation of his arm. However, work-up uncovered a periosteal extra-digital glomus tumor on the base of the small finger metacarpal. Results: Surgical excision of the lesion resulted in rapid resolution of his pain and normal hand function was ultimately restored. Conclusions: Glomus tumors account for up to 5% of all soft tissue tumors of the upper extremity, occurring most frequently within or adjacent to the nail bed. Time from onset of symptoms to correct diagnosis may not be established for many years, especially with atypical tumor locations. Although glomus tumors have been widely reported, atypical locations of these tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy. Furthermore, when evaluating a chronic pain patient, our findings support the opinion that assignment of the diagnosis of CRPS should only be a diagnosis of exclusion.
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Affiliation(s)
- Dean W. Smith
- The University of Texas Health Science Center
at Houston, USA,Dean W. Smith, Department of Orthopaedic Surgery,
The University of Texas Health Science Center at Houston, 6400 Fannin, Suite 1700,
Houston, TX 77030, USA.
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44
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Lee SY, Min J, Jeong Y, Sung K. The Usefulness of the Ultrasonography in the Diagnosis of an Extradigital Glomus Tumor. Ann Dermatol 2020; 33:97-99. [PMID: 33911822 PMCID: PMC7875212 DOI: 10.5021/ad.2021.33.1.97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sang-Yeul Lee
- Department of Plastic and Reconstructive Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Joonhong Min
- Department of Dermatology, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Yeonjin Jeong
- Department of Plastic and Reconstructive Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Kunyong Sung
- Department of Plastic and Reconstructive Surgery, Kangwon National University College of Medicine, Chuncheon, Korea
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Wang Y, Xiang Y, Bian Y, Feng B, Liu Y, Zhou X, Zhou L, Weng X. Glomus tumors associated with the bone and joints: a review of 91 cases. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1460. [PMID: 33313205 PMCID: PMC7723542 DOI: 10.21037/atm-20-6998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Glomus tumors (GTs) commonly affect the subungual soft tissue but rarely affect the bone and joints. Meanwhile, GTs associated with the bone and joints have been misdiagnosed for decades. Methods The PubMed, Embase, and Web of Science databases were searched, and primary data extracted from selected articles were quantitively analyzed. Results The number of male and female patients was 52 and 39, respectively, and the right side was more commonly affected than the left. The median age at onset of male and female patients was 43.61±19.20 and 33.16±14.87 years, respectively, and the median illness duration was 3.00 (1.00, 10.00) and 3.00 (0.50, 7.50) years, respectively. The median follow-up time was 12 months, and the median time to recurrence or metastasis was also 12 months. Of the 91 total cases, 3 had a malignant pathological type and 4 had an uncertain malignant potential. Moreover, five cases recurred postoperatively, including two malignant cases, two benign GTs, and one case of glomangiomatosis. Of the 54 patients with recorded data on trauma, 12 reported a definite history of trauma. Conclusions Interestingly, the history of trauma is an important cause of GTs. The most common site of extra-subungual tissue is the knee, especially in young adults. Surgical removal was the most commonly used treatment method, and radiotherapy and chemotherapy can be combined if necessary. Furthermore, patients should be followed up for at least 2 years postoperatively to monitor for possible recurrence. Fortunately, most patients with GTs have a good prognosis.
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Affiliation(s)
- Yingjie Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Yongbo Xiang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Yanyan Bian
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Bin Feng
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Yong Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Xi Zhou
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Lizhi Zhou
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Xisheng Weng
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
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Kumar S, Tiwary SK, More R, Kumar P, Khanna AK. Digital glomus tumor: An experience of 57 cases over 20 years. J Family Med Prim Care 2020; 9:3514-3517. [PMID: 33102323 PMCID: PMC7567209 DOI: 10.4103/jfmpc.jfmpc_446_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/25/2020] [Accepted: 05/11/2020] [Indexed: 11/04/2022] Open
Abstract
Background Glomus tumors are rare tumors and may affect any area of the body, but digits, palms, and soles are commonly affected due to higher number of glomus body. We present our experience with the management of 57 cases of glomus tumors of the fingertips treated over a period of 20 years (2000-2019). Materials and Methods Medical records of 57 cases with glomus tumors treated over a period of 20 years were reviewed for patient demographics, presenting characteristics, duration, previous treatment history, physical examination, investigation, treatment, follow-up, and recurrence. Results In our study, the mean age was 49 years, with age 47 years among women and 53 years among men suggesting glomus tumor as a disease of past middle age. The total number of cases was 57 with 44 women and 13 men. Site of lesion was nail bed in 50 cases (87.7%) and tip of finger in 7 cases (12.3%). In clinical assessment pinpoint tenderness was present in all 57 cases (100%) and pain in 56 cases (98.8%). Other features at the time of presentation were nodularity in 38 cases (66.6%), deformed nail in 14 cases (24.6%), and cold hypersensitivity in 20 cases (35.1%). The mean duration of the disease was 2.3 years (1.2-5.6 years). Conclusion One of the most painful clinical conditions confirmed by comprehensive clinical assessment and cured dramatically by complete surgical excision.
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Affiliation(s)
- Satendra Kumar
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Satyendra K Tiwary
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Raghunath More
- Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Puneet Kumar
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ajay K Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Bradburn KN, Beleckas CM, Peck KM, Kaplan FT, Merrell GA. Enigmatic and Unusual Cases of Upper Extremity Pain: Mislabeling As Malingerers. J Hand Surg Am 2020; 45:972-976. [PMID: 32674917 DOI: 10.1016/j.jhsa.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/16/2020] [Accepted: 04/07/2020] [Indexed: 02/02/2023]
Abstract
With the intricate anatomy of the hand and upper extremity, there are many possible etiologies of pain. In addition, one must be alert to conditions typically affecting other areas of the body presenting in the hand and upper extremity. To add to the complexity of diagnosis, one must also be aware of potential secondary gains. With this in mind, a thorough history, physical examination, and broad differential can help avoid mislabeling patients with uncommon ailments. In this article, we present 4 cases of unusual causes of hand and upper extremity pain.
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48
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Extra digital glomus tumor: A very rare cause of chronic abdominal wall pain. Int J Surg Case Rep 2020; 75:78-80. [PMID: 32919334 PMCID: PMC7490988 DOI: 10.1016/j.ijscr.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 11/22/2022] Open
Abstract
Glomus tumor is mostly seen in the digits and very rarely present in the other parts of the body including abdominal wall. Other more common causes of abdominal pain should be ruled out first before labeling the glomus tumor as a cause. Excisional biopsy is the best diagnostic modality for diagnosing and also treatment of choice in glomus tumor.
Introduction Glomus tumors are very rare benign vascular tumors, constituting less than 2% of soft tissue tumors. These tumors originate from the glomus body. 75% of these tumors occur in hand however rarely can be found in any body part. Presentation of case We here report a case of glomus tumor who presented with abdominal pain (constant and throbbing nature) and small swelling in the left hypochondrium. Pain was mostly spontaneous without any obvious cause, aggravated by cold and palpation. Ultrasonography parietal wall showed 27 × 22 × 21 mm hypoechoic lesion in the parietal wall with increased focal vascularity. Histopathological examination confirmed the diagnosis of glomus tumor. Discussion These are rare benign vascular tumors arising from the glomus bodies found anywhere in body. However 75% are found in hand mostly subungual region. Glomus tumor may show unusual clinical picture such as extra digital location, large size, deep soft tissue, visceral location, multi-centric or infiltrative growth pattern. These tumor commonly presents with a diagnostic triad of spontaneous pain, hypersensitivity to drop in temperature and pressure tenderness. Clinical diagnostic tests aide in diagnosis, including Love’s test, Hildreth’s test, Transillumination and the cold test. The clinical differential diagnosis of glomus tumor includes Raynaud’s phenomenon, neuroma, gout, infection, peripheral neuropathy and radiculopathy. Conclusion Extra digital glomus tumor occur in any part of the body and should be put in differential diagnosis of abdominal pain when no obvious cause of pain is found. Surgical excision is the curative treatment of choice with rare recurrence.
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Christian BP. Extradigital glomus tumor of the anterior knee. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2020; 7:105-107. [PMID: 32939365 PMCID: PMC7470091 DOI: 10.1080/23320885.2020.1810579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The benign glomus tumor is an uncommon cause of crippling pain most commonly associated with the fingers. This sheep in wolf’s clothing is identified by careful examination, confirmed by MRI, and often resolved with a simple procedure. Here we present a patient with chronic knee pain of 21 years duration.
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50
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Batra V, Batta NS, Gupta A. Giant glomus tumor of the knee mimicking soft-tissue sarcoma. INDIAN JOURNAL OF MUSCULOSKELETAL RADIOLOGY 2020; 2:82-86. [DOI: 10.25259/ijmsr_9_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Glomangiomas (glomus tumors) are benign vascular tumors commonly located at the distal extremities, are usually subungual lesions, and account for 2% of all soft-tissue tumors. Patients with digital glomus tumors present with hypersensitivity to cold, paroxysmal severe pain, and point tenderness. These tumors are infrequent in the knee area, and when seen are superficial, usually have a diameter of less than 1 cm, which make their radiological diagnosis arduous. We report a noteworthy, unusual case of a large glomus tumor in the popliteal fossa showing biceps femoris infiltration, in a 51-year-old female patient who experienced severe intermittent posterior knee pain for the past 2 years. Magnetic resonance imaging revealed a large popliteal inhomogeneous soft-tissue lesion with irregular margins insinuating the posterolateral musculature mimicking soft-tissue sarcoma. Histopathology revealed a glomus tumor.
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Affiliation(s)
- Vikas Batra
- Department of Radiology, Mahajan Imaging, Sports Injury Center, Safdarjung Hospital, New Delhi, India,
| | - Nafisa Shakir Batta
- Department of Radiology, Mahajan Imaging, Sports Injury Center, Safdarjung Hospital, New Delhi, India,
| | - Ankur Gupta
- Department of Radiology, Mahajan Imaging, Sports Injury Center, Safdarjung Hospital, New Delhi, India,
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