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Altarifi ME, Kalas A, Alnajjar A, Yasin Dali M, Alkhowailed MS. Glomus tumor: A rare differential diagnosis for subungual lesions. Radiol Case Rep 2024; 19:6034-6038. [PMID: 39345850 PMCID: PMC11437606 DOI: 10.1016/j.radcr.2024.08.116] [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: 05/17/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 10/01/2024] Open
Abstract
Glomus tumors are rare, benign vascular hamartomas of the glomus apparatus with unknown etiology. They can arise from anywhere in the body. However, up to 90% of them are located in the subungual region of the fingers, as in the case of our patient. These tumors typically present with the classic triad of pain, cold sensitivity, and point tenderness. Characteristic US and MRI findings aid the clinical diagnosis; nevertheless, a histopathologic examination is confirmatory. There is a well-documented mean delay in diagnosis of around 7 years, due to the rarity, benignity, small size, and lack of proper knowledge about the condition. However, we reported a case with a delay in diagnosis that reached 40 years, which is much longer than what is documented in the literature. A high index of suspicion is required for early diagnosis and management of glomus tumors to relieve the patient's long-term suffering and prevent possible secondary nail deformities. The curative treatment of glomus tumor is complete surgical excision, which is crucial to prevent recurrence and relieve the patient's symptoms.
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Affiliation(s)
- Mhd Ebrahim Altarifi
- Faculty of Medicine, Sulaiman Alrajhi University, Bukayriah, Qassim, Saudi Arabia
| | - Ammar Kalas
- Faculty of Medicine, Sulaiman Alrajhi University, Bukayriah, Qassim, Saudi Arabia
| | - Anas Alnajjar
- Department of Radiology, Graduate Medical Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Majd Yasin Dali
- Faculty of Medicine, Sulaiman Alrajhi University, Bukayriah, Qassim, Saudi Arabia
| | - Mohammad S․ Alkhowailed
- Department of Dermatology, College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia
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2
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Sechi A, Wortsman X, Tosti A, Iorizzo M. Advances in image-based diagnosis of nail disorders. J Eur Acad Dermatol Venereol 2024. [PMID: 39230323 DOI: 10.1111/jdv.20309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/02/2024] [Indexed: 09/05/2024]
Abstract
This paper provides a comprehensive overview of image-based techniques, particularly focusing on their applications and advancements in the context of nail disorders. Nowadays, high-resolution digital cameras and dermoscopes enable dermatologists to capture detailed images of nail abnormalities, facilitating early diagnosis and meticulous tracking of disease progression. Onychoscopy is now a routine technique with well-known criteria for the diagnosis, but recent developments allow us to visualize certain diseases better. Imaging modalities like high-frequency ultrasound, magnetic resonance imaging, optical coherence tomography and confocal microscopy are being increasingly adopted for their superior diagnostic capabilities. These techniques are described in their technology, scanning protocols, normal findings, advantages and limitations. Moreover, the integration of technology in patient education has fostered a more informed patient population, capable of actively participating in their disease monitoring and treatment regimens. Proper training, validation, regulation and ethical considerations are, however, essential when integrating technology into healthcare practices. Imaging technologies that present the potential to add critical anatomical information to clinical diagnoses within reasonable costs and are available worldwide are the ones that will probably be used the most.
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Affiliation(s)
- Andrea Sechi
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ximena Wortsman
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology - Mille School of Medicine, University of Miami, Miami, Florida, USA
| | - Matilde Iorizzo
- Private Dermatology Practice, Bellinzona/Lugano, Switzerland
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3
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Curtis KL, Ho B, Jellinek NJ, Rubin AI, Tosti A, Lipner SR. Diagnosis and management of longitudinal erythronychia: A clinical review by an expert panel. J Am Acad Dermatol 2024; 91:480-489. [PMID: 38705197 DOI: 10.1016/j.jaad.2024.04.032] [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] [Received: 01/29/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 05/07/2024]
Abstract
Longitudinal erythronychia (LE) is defined as a longitudinal red band of the nail(s) and is classified as localized (involvement of 1 nail) or polydactylous (involvement of more than 1 nail). The differential diagnosis is distinct for these classifications. The etiologies of localized longitudinal erythronychia are most frequently benign subungual neoplasms and less often malignancies. Polydactylous longitudinal erythronychia is typically secondary to regional or systemic diseases, including lichen planus and Darier disease. LE is a common but underrecognized clinical finding. Increased dermatologist awareness of the clinical characteristics and differential diagnosis for LE is necessary given the possibility for malignancy and associated systemic disease. In this clinical review, the clinical features, differential diagnosis, evaluation, and management of LE are described.
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Affiliation(s)
| | - Benedict Ho
- Weill Cornell Medical College, New York, New York
| | - Nathaniel J Jellinek
- Department of Dermatology, The Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
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Martini APS, Rosa AC, Rigatti M, Funchal GDG, Torres MHC, Pacheco MA. Diagnosis of glomus tumor and preoperative mapping with ultrasonography. An Bras Dermatol 2024:S0365-0596(24)00147-8. [PMID: 39217067 DOI: 10.1016/j.abd.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 09/04/2024] Open
Affiliation(s)
| | - Ariel Córdova Rosa
- Hospital Universitário da Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Marcelo Rigatti
- Hospital Universitário da Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | | | - Matheus Alves Pacheco
- Hospital Universitário da Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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de Almeida CÁ, Nakamura R, Leverone A, Marchiori E, Canella C. High-frequency ultrasonography for subungual glomus tumor evaluation - imaging findings. Skeletal Radiol 2024; 53:891-898. [PMID: 37945770 DOI: 10.1007/s00256-023-04506-1] [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: 08/28/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE This article aimed to describe the common imaging features of subungual glomus tumors. METHODS The study involved data collected between January 2019 and December 2022. Twenty-three patients with a total of 31 glomus tumors underwent high-frequency ultrasound examinations with a 24-MHz probe. Two experienced radiologists independently evaluated the images, and only data from the more experienced radiologist were used for subsequent analyses. RESULTS The average size of the tumors was 4.6 mm, and most of them appeared homogeneously hypoechogenic (90.3%). Bone remodeling of the distal phalanx was observed in 87.1% of cases, with an average axial circumference loss of 0.8 mm, indicating the slow and expansive growth of glomus tumors. Intense vascularization was found in 54.8% of cases on Doppler images, and the stalk sign, reflecting the vascular origin of the tumor, was present in 64.5% of cases. The most common clinical feature was pain, reported in 84.6% of cases, with a mean pain scale score of 7.0, indicating a negative impact on patients' lives despite being benign tumors. CONCLUSION The study concludes that ultrasound evaluation is highly useful for diagnosing glomus tumors, especially when multiple findings, such as bone remodeling, hypervascularization, and the stalk sign, are present. This method allows for accurate diagnosis, observation of periungual structures, and proper surgical planning, ultimately reducing recurrence rates.
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Affiliation(s)
- Carolina Ávila de Almeida
- Department of Radiology, Diagnósticos da América S/A (DASA), Rio de Janeiro, Rio de Janeiro, Brazil.
- Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Robertha Nakamura
- Department of Dermatology, Centro de Estudos das Unhas, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andreia Leverone
- Department of Dermatology, Centro de Estudos das Unhas, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Edson Marchiori
- Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Clarissa Canella
- Clínica Alta Excelência Diagnóstica, DASA, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Radiology, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
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Dhingra M, Niraula BB, Regmi A, Bansal S, Singh V, Phulware RH. Glomus Tumour of Hand--A Commonly Misdiagnosed Pathology: A Case Series. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:39-45. [PMID: 36590779 PMCID: PMC9802603 DOI: 10.4103/jwas.jwas_171_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/13/2022] [Indexed: 01/03/2023]
Abstract
Introduction Glomus tumours are benign neoplasms arising from the glomus body, a network of specialized neuromyoarterial structures containing arteriovenous anastomosis and regulating temperature. It is often misdiagnosed as paronychia, arthritis, traumatic sequelae, and many other conditions including psychiatric misdiagnosis. A typical triad of paroxysmal pain, point tenderness, and cold intolerance characterize it. Surgical excision is the treatment of choice, either by transungual or lateral approaches. Materials and Methods We carried out a retrospective study of cases operated in our department in the last 4 years. Patients are evaluated based on either clinical parameters (Love test, Hildreth test, and cold insensitivity) or radiological parameters (X-ray and magnetic resonance imaging). Parameters such as age, gender, tumour side, presenting complaints, duration of symptoms, diagnostic modality, follow-up duration, recurrence, and postoperative nail deformity were analysed. Visual analogue scale (VAS) score was the primary statistical parameter, and the change in VAS score following surgery was analysed with paired t test. Result Mean preoperative VAS was 7.75 ± 0.5; in a total of four patients, and following surgery, VAS was reduced to a mean of 1 ± 1.5. Paired t test on the change of VAS score following surgery showed a significant difference in the VAS score (P = 0.002838). The average age was 39.25. The male-to-female ratio was 1:3, and the mean follow-up was 16 months (range 2-48 months). The mean duration of symptoms was 5.75 years (range 2-10 years). Two cases were in the right-hand side, and two cases were on the left-hand side; the thumb was most commonly involved with 50% (n = 2) incidence. Conclusion Glomus tumours are often misdiagnosed and are intervened with different treatment options before being surgically intervened. With complete surgical excision, recurrence is nil but postoperative nail growth requires nearly 10 months. Level of Evidence Level IV.
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Affiliation(s)
- Mohit Dhingra
- Department of Orthopedics, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - Bishwa Bandhu Niraula
- Department of Orthopedics, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - Anil Regmi
- Department of Orthopedics, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - Shivam Bansal
- Department of Orthopedics, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - Vivek Singh
- Department of Orthopedics, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - Ravi Hari Phulware
- Department of Orthopedics, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
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Muacevic A, Adler JR. Hand and Foot Glomus Tumors: Significance of MRI Diagnosis Followed by Histopathological Assessment. Cureus 2022; 14:e30038. [PMID: 36381782 PMCID: PMC9637391 DOI: 10.7759/cureus.30038] [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: 10/07/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Glomus tumors are benign lesions with hamartomatous proliferation in the neuromyoarterial glomus bodies. Glomus tumors are small, reddish, painful blue nodules usually underneath the fingernail. Objectives This study is mainly focusing on magnetic resonance imaging (MRI) findings of glomus tumors on T1, T2, short inversion time inversion recovery (STIR), and post-gadolinium images. Further study of clinical and histopathological findings to support the radiological diagnosis. Material & methods The retrospective study included an elaborate study of MRI imaging findings of 24 cases of glomus tumors of the hand and leg at a tertiary care center in Udaipur. Patients with imaging findings confirmed on histopathology were included in the study. MRI study was conducted using a 3-T MR unit and a high-spatial-resolution module. Results A total of 24 cases of glomus tumors were diagnosed during the six years between January 2015 and November 2020. Out of 24 patients, 14 were female and 10 were male. The most common site of involvement was a hand, followed by a foot. All 24 cases showed isointense to hyperintense lesions on T2-weighted images with a conspicuous hyperintense lesion on STIR images. Further histopathological examination confirmed the diagnosis showing nests of monomorphic tumor nuclei arranged in a perivascular pattern. Conclusion Glomus tumors can present with variable pain. A high index of suspicion is needed for diagnosis. Contrast MRI has a significant role in the diagnosis of glomus tumors. The clinical and histopathological picture further confirms the diagnosis. MRI imaging is further supportive to differentiate postoperative fibrosis from residual or recurrent tumors.
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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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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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Kapogiannis F, Tsiampa E. Glomus Tumor of the Kidney Harboring Malignant Potential. Cureus 2021; 13:e19479. [PMID: 34912620 PMCID: PMC8664362 DOI: 10.7759/cureus.19479] [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: 11/11/2021] [Indexed: 11/09/2022] Open
Abstract
Glomus tumors are rare, benign, vascular neoplasms arising from the glomus body. Although they occasionally develop in any part of the body, they do so more common in the upper extremities, most frequently subungual areas. An extensive review of the literature revealed less than thirty cases of primary renal glomus tumors. We present a unique case of an adult male with an incidentally discovered 2.5 cm right renal mass. Histopathologic and immunohistochemical examination suggested the diagnosis of glomus tumor. Based on the World Health Organization (WHO) classification of soft tissue tumors, the presence of at least two atypical features indicates malignant potential. In this case, deep/visceral location and size greater than 2 cm fulfilled these criteria. Following an uneventful excision and a 12-month follow-up period, the patient remains disease-free with no sign of local or distant metastases.
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Affiliation(s)
| | - Eleni Tsiampa
- Obstetrics and Gynaecology, General Hospital of Helena Venizelou, Athens, GRC
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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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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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Saba M, Moser A, Rosenberg J, Qiao JH, Chen G. Rare glomus tumor formation following trauma to the first digit. Int J Surg Case Rep 2021; 86:106324. [PMID: 34425425 PMCID: PMC8387767 DOI: 10.1016/j.ijscr.2021.106324] [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: 05/08/2021] [Revised: 07/25/2021] [Accepted: 08/15/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Glomus tumors are rare and few cases are reported in the literature. They typically occur in females on the digits of the hands. CASE PRESENTATION We report a case of a 30 year-old woman who presented with a mass that developed on the distal tip of her right thumb after traumatic injury. Magnetic resonance imaging (MRI) was conducted and mass resection was performed. Histopathology confirmed that the mass was a glomus tumor. CLINICAL DISCUSSION Clinical presentations of glomus tumors are typically non-specific, mainly consisting of a small mass with chronic pain, with a lengthy time to diagnosis and potentially improper management. MRI is the preferred diagnostic step, followed by curative surgical excision and pathological confirmation. CONCLUSION Glomus tumors can cause significant discomfort for patients, and clinicians should be aware of the rare diagnosis when treating painful masses on the extremities, as surgical excision is often curative.
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Affiliation(s)
- Mohammad Saba
- Ross University School of Medicine, 2300 SW 145TH AVE, SUITE 200, Miramar, FL 33027, USA; California Hospital Medical Center, 1401 S GRAND AVE, Los Angeles, CA 90015, USA.
| | - Austin Moser
- Ross University School of Medicine, 2300 SW 145TH AVE, SUITE 200, Miramar, FL 33027, USA; California Hospital Medical Center, 1401 S GRAND AVE, Los Angeles, CA 90015, USA.
| | - Joshua Rosenberg
- Ross University School of Medicine, 2300 SW 145TH AVE, SUITE 200, Miramar, FL 33027, USA; California Hospital Medical Center, 1401 S GRAND AVE, Los Angeles, CA 90015, USA.
| | - Jian-Hua Qiao
- California Hospital Medical Center, 1401 S GRAND AVE, Los Angeles, CA 90015, USA.
| | - Gary Chen
- California Hospital Medical Center, 1401 S GRAND AVE, Los Angeles, CA 90015, USA.
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Abstract
This article describes nail tumors and their clinical features, biologic behavior, and treatment. Tumors included are onychopapilloma, onychomatricoma, periungual fibromas/fibrokeratomas, glomus tumors, subungual exostosis, myxoid cysts, and squamous cell carcinoma.
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15
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Grover C, Jayasree P, Kaliyadan F. Clinical and onychoscopic characteristics of subungual glomus tumor: a cross-sectional study. Int J Dermatol 2020; 60:693-702. [PMID: 33332614 DOI: 10.1111/ijd.15358] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/12/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Subungual glomus tumor is a relatively uncommon entity with varied clinical presentations which may lead to diagnostic delays. Onychoscopy can be used as an evaluation tool in routine evaluation of glomus tumors. OBJECTIVES AND METHODS With an aim to characterize the onychoscopic features of subungual glomus tumors, we analyzed 15 cases presenting over 3 years, in this observational study. The clinical, onychoscopic, radiological, and operative findings in these patients were evaluated and correlated depending on the location and extent of the lesions. RESULTS All 15 patients (11 female and 4 male) had pain as the presenting symptom and fulfilled the classic triad of paroxysmal pain, cold sensitivity, and positive Love's pin test. Clinical nail plate findings included onycholysis, onychorrhexis with distal splitting, and onychoschizia, while nail bed and matrix findings included localized erythematous and bluish patches, longitudinal erythema, and altered lunula. Onychoscopy corroborated the clinical findings and revealed a more extensive area of involvement in five cases. Definitive onychoscopy findings included a localized structureless erythema interspersed with bluish and patchy whitish areas (five cases of nail bed and six nail matrix tumors) and a "candy-cane appearance" (six cases, all large and lobulated nail matrix tumors). MRI reported the tumor in 13 cases, while two nail matrix tumors were missed. Transungual excision revealed tumors larger in size than predicted by MRI. The presence of candy-cane appearance was consistent with lobulated matrix tumors. CONCLUSION Onychoscopy improves the intraoperative detection of location and extent of subungual glomus tumors. Nail bed and nail matrix glomus tumors can have distinctive onychoscopic features that may help in better surgical planning.
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Affiliation(s)
- Chander Grover
- Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | | | - Feroze Kaliyadan
- Faculty of Dermatology, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
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Bouayyad S, Abdelaty M, Mishra A. A 15-year mystery resolved: a large bone-boring glomus tumor mistaken as dermatitis. J Surg Case Rep 2020; 2020:rjaa013. [PMID: 32099641 PMCID: PMC7031057 DOI: 10.1093/jscr/rjaa013] [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: 12/26/2019] [Revised: 01/19/2020] [Accepted: 01/25/2020] [Indexed: 11/13/2022] Open
Abstract
Glomus tumor (GT) is a rare, benign neoplasm of the glomus apparatus. Being most common in the subungual region, it often misdiagnosed with dermatological conditions. Severe tenderness, paroxysmal pain and cold intolerance symptomatically denote GT. Clinical tests such as Love's pin test and Hildreth's test assist in diagnosing the disease. X-ray, ultrasonography and magnetic resonance imaging can confirm the severity of the lesion. Complete surgical excision is the only treatment available for these subcutaneous nodules. A middle-aged male with a hand pain, who misdiagnosed for dermatitis over 15-year period, has identified as having a large bone-boring GT. Awareness of GT among healthcare professionals is a must to increase the quality of life of patients.
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Affiliation(s)
- Sarah Bouayyad
- Plastic Surgery and Burns, Whythenshaw Hospital, Manchester, UK
| | | | - Anuj Mishra
- Plastic Surgery and Burns, Whythenshaw Hospital, Manchester, UK
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Vasilevska-Nikodinovska V, Samardjiski M, Jovanovik R, Ilievski B, Janevska V. Low-Grade Malignancy Glomus Tumor in a Setting of Multiple Glomus Tumors - Case Report. Open Access Maced J Med Sci 2019; 7:4082-4088. [PMID: 32165957 PMCID: PMC7061405 DOI: 10.3889/oamjms.2019.610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/15/2019] [Accepted: 12/16/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Glomus tumors are rare neoplasms accounting for less than 2% of all soft tissue tumors but multiple lesions may be seen in up to 10% of the patients. Solitary glomus tumor (GT) most frequently appears as small nodule in specific locations such as subungual region or deep dermis. However, rarely these entities have been observed in extracutaneous locations such as the gastrointestinal, cardiovascular, respiratory tracts, and other visceral organs. A small fraction of the GTs may present as tumors of uncertain malignant potential or as malignant glomus tumors. CASE PRESENTATION: We report a patient with multiple glomus tumors on the time of diagnosis, which was histologically diagnosed as an atypical glomus tumor following resection of a tumor thrombus in the left renal vein, inferior vena cava trombus with intracardial extension, and mitral valve specimen. The intramuscular lesion from the thigh was diagnosed as a glomus tumor of uncertain malignant potential. Further examinations revealed multiple lesions trough her body: kidneys, breast, heart and subcutaneous tissue. The diagnosis of glomus tumor of uncertain malignant potential versus glomus tumor with low malignant potential could be quite challenging, and the clinical course may be as a determining factor for final diagnosis. CONCLUSION: To our knowledge, this is the only known case of glomus tumor with multiple organ involvement and aggressive biological behavior at presentation.
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Affiliation(s)
| | - Milan Samardjiski
- University Orthopedic Clinic, Clinical Center "Mother Theresa", Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Rubens Jovanovik
- Institute of Pathology, Faculty of Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Boro Ilievski
- Institute of Pathology, Faculty of Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Vesna Janevska
- Institute of Pathology, Faculty of Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Surgical Resection of Occult Subungual Glomus Tumors: Cold Sensitivity and Sonographic Findings. Ann Plast Surg 2019; 81:411-415. [PMID: 29975235 DOI: 10.1097/sap.0000000000001555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We surgically treated subungual masses that were suspected glomus tumors, although definitive clinical and radiological findings were lacking. We report the outcomes of a retrospective case series. METHODS Of 42 patients treated by surgical resection between March 1996 and December 2015, 7 who met our inclusion/exclusion criteria were evaluated. At least 1 symptom of the typical triad (temperature sensitivity, severe pain, and localized tenderness) was absent, and computed tomography (CT) and magnetic resonance imaging (MRI) findings were normal. After ultrasonographic evaluation, we resected the masses using a transungual approach or a nail-preserving method. After pathological confirmation of the diagnosis, we followed all patients for at least 2 years to evaluate tumor recurrence and nail deformity. RESULTS In 5 patients, cold sensitivity was the only symptom; no physical finding was suggestive of a glomus tumor. Tenderness was evidenced by the 2 patients who lacked cold sensitivity. None of the 7 patients exhibited CT or MRI abnormalities, but small acoustic shadows were evident in 4 patients, and blood-rich nodules were noted in 2 patients. The mean diameter of the 7 tumors was 2.1 mm, and pathological examination revealed typical glomus bodies. No major surgery-associated complication developed during follow-up. The final mean visual analog scale score (assessing pain) improved to 0.3 from the mean preoperative value of 3.6. CONCLUSIONS Small glomus tumors exhibit few traditional symptoms and signs and no definitive radiological CT/MRI finding. However, cold sensitivity alone is a powerful surgical indication, and occasionally, ultrasonographic findings are useful even in the absence of CT/MRI findings.
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Antoinette Bargon C, Mohamadi A, Talaei-Khoei M, Ring DC, Mudgal CS. Factors Associated with Requesting Magnetic Resonance Imaging during the Management of Glomus Tumors. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:422-428. [PMID: 31742218 PMCID: PMC6802551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 02/25/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The characteristic clinical presentation of glomus tumors and the low negative predictive value of the magnetic resonance imaging (MRI) raise the question whether MRI improves their management. Therefore, this study aimed to investigate whether MRI improved the management of glomus tumors. METHODS In total, 87 patients with a histologically confirmed glomus tumor were treated over a 25-year period and analyzed retrospectively. Multivariable logistic regression analysis was used to evaluate the independent predictors of an MRI request during the management of glomus tumors. RESULTS ccording to the results, the patients who were treated by orthopaedic surgeons were more likely to have an MRI during the management of a glomus tumor. CONCLUSION The role of an MRI during the management of a glomus tumor is unclear. Orthopaedic surgeons are more likely to request an MRI. Furthermore, visible lesions with characteristic symptoms probably do not benefit from MRI. However, it may help to be sure that the highest-quality MRI is used with the best possible coil for the finger.
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Affiliation(s)
- Claudia Antoinette Bargon
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Dell Medical School, the University of Texas, Austin, USA
- Research performed at Massachusetts General Hospital in Boston, Boston, Massachusetts, USA
| | - Amin Mohamadi
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Dell Medical School, the University of Texas, Austin, USA
- Research performed at Massachusetts General Hospital in Boston, Boston, Massachusetts, USA
| | - Mojtaba Talaei-Khoei
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Dell Medical School, the University of Texas, Austin, USA
- Research performed at Massachusetts General Hospital in Boston, Boston, Massachusetts, USA
| | - David C Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Dell Medical School, the University of Texas, Austin, USA
- Research performed at Massachusetts General Hospital in Boston, Boston, Massachusetts, USA
| | - Chaitanya S Mudgal
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Dell Medical School, the University of Texas, Austin, USA
- Research performed at Massachusetts General Hospital in Boston, Boston, Massachusetts, USA
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Mundada P, Becker M, Lenoir V, Stefanelli S, Rougemont AL, Beaulieu JY, Boudabbous S. High resolution MRI of nail tumors and tumor-like conditions. Eur J Radiol 2019; 112:93-105. [DOI: 10.1016/j.ejrad.2019.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/30/2018] [Accepted: 01/04/2019] [Indexed: 11/17/2022]
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Kim YJ, Kim DH, Park JS, Baek JH, Kim KJ, Lee JH. Factors affecting surgical outcomes of digital glomus tumour: a multicentre study. J Hand Surg Eur Vol 2018; 43:652-658. [PMID: 29754525 DOI: 10.1177/1753193418774176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This was a retrospective, multicentre study using data from four medical institutions of 72 patients of histologically confirmed digital glomus tumour removed by surgical excision. Mean follow-up period was 5.4 years. We investigated clinical outcomes and analysed the relationship between primary glomus tumour size, radiographic bony erosion, anatomic location, surgical approach, and surgical method as risk factors for recurrence. Complications and recurrence rate according to surgical approach and surgical method were compared. At final follow-up, recurrence was observed in five (6.9%) patients. Postoperative complications were observed in nine (12.5%), with two patients having numbness of fingertips, and seven having nail deformities. In a group with pulp lesions for which a direct approach was used and in a surgical loupe group, recurrence rates were high, however, this was not statistically significant. A nail-sparing approach and microscopic excision did not lower the incidence of nail deformities. No risk factors that significantly predicted recurrence were found. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Young Jun Kim
- 1 Department of Orthopedic Surgery, Busan Paik Hospital, Busan, Korea
| | - Dong Hee Kim
- 2 Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan, Korea
| | - Jin Sung Park
- 3 Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Jong Hun Baek
- 4 Department of Orthopedic Surgery, Kyung Hee University, Seoul, Korea
| | - Kyu Jin Kim
- 5 Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jae Hoon Lee
- 5 Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Fan Z, Wu G, Ji B, Wang C, Luo S, Liu Y, Yuan J. Color Doppler ultrasound morphology of glomus tumors of the extremities. SPRINGERPLUS 2016; 5:1319. [PMID: 27563514 PMCID: PMC4980861 DOI: 10.1186/s40064-016-2883-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/20/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the value of color Doppler flow imaging (CDFI) in the diagnosis of glomus tumors in the extremities. METHODS Sonography results of 62 nodules of 50 patients with glomus tumors in the extremities confirmed by surgery and pathology were analyzed retrospectively. RESULTS The sex ratio in the group of 50 patients was (female:male) = 5.25:1. Glomus tumors were more common in women aged 30-40 years. 84 % (42/50) of glomus tumors occurred in the fingers, with the thumb being the most common. 2D results showed that 64.52 % (40/62) of 62 nodules were hypoechoic, 30.65 % (19/62) were heterogeneous echo, 4.84 % (3/62) were hyperechoic; 64.52 % (40/62) had a clear border, while 35.48 % (22/62) had an unclear border. CDFI showed that 38.71 % (24/62) had visible rich blood in the tumor, 35.48 % (22/62) had little visible blood in the tumor, and 25.81 % (16/62) had no significant intratumoral blood flow. Of the 50 patients, 92 % (46/50) showed a fixed contact pain, were sensitive to cold stimuli, which was improved by hot water and air, and for which anti-inflammatory treatment was ineffective. CONCLUSION Glomus tumors in the extremities had certain ultrasound features, and its internal blood flow was diverse. Understanding this feature may be helpful for the diagnosis of non-typical glomus tumors.
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Affiliation(s)
- Zhina Fan
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
| | - Gang Wu
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
| | - Bing Ji
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
| | - Cunfeng Wang
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
| | - Shuaiwei Luo
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
| | - Yinlong Liu
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
| | - Jianjun Yuan
- Department of Ultrasonography, Henan Provincial People’s Hospital, Zhengzhou, 450003 China
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Morey VM, Garg B, Kotwal PP. Glomus tumours of the hand: Review of literature. J Clin Orthop Trauma 2016; 7:286-291. [PMID: 27857505 PMCID: PMC5106475 DOI: 10.1016/j.jcot.2016.04.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/21/2015] [Accepted: 04/23/2016] [Indexed: 11/25/2022] Open
Abstract
Glomus tumours are rare benign vascular neoplasms commonly found in the hand particularly in subungual region. Though, its aetiology remains largely unknown, several hypotheses have been made to explain the etiopathogenesis and cause of pain. These tumours usually present as a bluish or pinkish red discolouration of the nail plate with classical triad of localised tenderness, severe pain, and cold sensitivity. Nevertheless, differential diagnosis of other painful tumours, such as leiomyoma, eccrine spiradenoma, haemangioma, neuroma, osteochondroma, or mucous cyst should always be kept in mind while evaluating a patient with severe pain in the tip of the finger. In addition to the different clinical tests including Love's pin test, Hildreth's test, and trans-illumination test, imaging studies such as magnetic resonance imaging (MRI), ultrasonography, and radiography are often helpful in the diagnosis. Complete surgical excision is a must to get complete relief from the symptoms and to avoid recurrence. Several approaches have been described in the literature. Different surgeons may have different choices and may prefer one approach over the other depending on the anatomical location of the tumours. The purpose of this article is to review the important aspects of glomus tumours in hand concerning their aetiology, clinical presentation, diagnosis, management, and recurrence.
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Affiliation(s)
| | - Bhavuk Garg
- All India Institute of Medical Sciences, New Delhi, India,Corresponding author at: Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi 110029, India.Department of Orthopaedics, All India Institute of Medical SciencesNew Delhi110029India
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24
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Asymptomatic Glomus Tumor of the Mediastinum. Case Rep Surg 2015; 2015:631625. [PMID: 26442165 PMCID: PMC4579308 DOI: 10.1155/2015/631625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 11/18/2022] Open
Abstract
Glomus tumors are rare benign neoplasms that predominate in limbs. Infrequently, they can occur in a wide anatomic distribution, to include sites not known to contain glomus cells. Although glomus tumors are usually small, pain and tenderness are common clinical symptoms. We report the case of a 69-year-old man with an asymptomatic large mediastinal glomus tumor, who underwent surgical resection.
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25
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Nail-preserving modified lateral subperiosteal approach for subungual glomus tumour: a novel surgical approach. Musculoskelet Surg 2015; 100:43-8. [PMID: 25957553 DOI: 10.1007/s12306-015-0374-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Glomus tumours are benign, vascular neoplasms arising from glomus body and are often found near the fingertips. Complete surgical excision of the tumour must be ensured to avoid its recurrence. Several surgical approaches for its excision have been described in the literature; however, most of the approaches are associated with nail deformity in the post-operative period or fail to offer a complete exposure of the tumour. We wish to share our experience with our described nail-preserving modified lateral subperiosteal approach, where on account of the distal curve over the pulp tip, we achieve a large flap yielding an excellent exposure of the tumour mass. METHODS We retrospectively evaluated 30 patients with subungual glomus tumour who were operated using this approach at a mean follow-up of 35.33 months. All patients were assessed for relief in the pre-operative symptoms, nail deformity, recurrence or any other complications. RESULTS All wounds healed well without any possible wound complications such as wound dehiscence, suture margin necrosis or infection. At the end of the follow-up, all patients were relieved of the pre-operative symptoms. There was no evidence of deformity of nail or fingertip. No patient had recurrence. All the operated fingers were functionally normal. CONCLUSIONS Nail-preserving modified lateral subperiosteal approach does not damage the nail bed or interosseous supports to the distal phalanx. It is a very simple, less time-consuming approach for the resection of subungual tumours, and we would like to recommend it to our fellow orthopaedic surgeons.
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Trehan SK, Athanasian EA, DiCarlo EF, Mintz DN, Daluiski A. Characteristics of glomus tumors in the hand not diagnosed on magnetic resonance imaging. J Hand Surg Am 2015; 40:542-5. [PMID: 25639840 DOI: 10.1016/j.jhsa.2014.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/02/2014] [Accepted: 12/02/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether the diagnosis of hand glomus tumors by magnetic resonance imaging (MRI) is associated with tumor size, tumor pathology, tumor location, and/or clinical suspicion. METHODS We reviewed our pathology database for patients with hand glomus tumors diagnosed between 2006 and 2013 and included those patients who had preoperative MRI at our institution. We excluded patients with recurrent and persistent tumors. Magnetic resonance imaging reports were reviewed for clinical history, tumor location, and associated bone erosion. Pathology reports were reviewed for diagnosis and tumor size. We classified MRI studies as positive (glomus tumor diagnosis), negative (no mention of glomus tumor as possible diagnosis), or indeterminate (glomus tumor mentioned as possible differential diagnosis). Fisher exact test was used to compare positive studies and those that were nondiagnostic (ie, either negative or indeterminate). RESULTS Of the 46 patients who had pathologically confirmed hand glomus tumors, 38 had preoperative MRI studies. A total of 24 MRI studies were positive, 5 were indeterminate, and 7 were negative. Five patients had atypical pathology, 1 had a multifocal tumor, and 2 had extra-digital hand glomus tumors. Failure to diagnose glomus tumors on MRI was associated with atypical pathology, atypical location (ie, not located in the subungual region), absence of bone erosion, and lack of clinical suspicion. Tumor size was not associated with MRI diagnosis. CONCLUSIONS In this series of 36 hand glomus tumors, one-third of MRI studies were nondiagnostic. Occurrence of nondiagnostic MRIs was more likely when glomus tumors were pathologically and/or anatomically atypical, without bone erosion, and with no or unrelated clinical history provided. These findings highlight the continued importance of clinical suspicion in glomus tumor diagnosis. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.
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Affiliation(s)
- Samir K Trehan
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Department of Pathology, Hospital for Special Surgery, New York, NY; Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Edward A Athanasian
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Department of Pathology, Hospital for Special Surgery, New York, NY; Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Edward F DiCarlo
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Department of Pathology, Hospital for Special Surgery, New York, NY; Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Douglas N Mintz
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Department of Pathology, Hospital for Special Surgery, New York, NY; Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Aaron Daluiski
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Department of Pathology, Hospital for Special Surgery, New York, NY; Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY.
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Scaravilli G, Rossi R, Artiaco S, Merolla G. Glomus tumor of the thenar eminence in neurofibromatosis type 1: case report and literature review. Transl Med UniSa 2014; 11:63-8. [PMID: 25674553 PMCID: PMC4309659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a disease characterized by increased tumorigenesis susceptibility, caused by mutations of the oncosuppressor gene NF1. The glomus tumor (GT) is a rare, very painful mesenchymal neoplasm, arising from the glomus body. In recent years, it has been highlighted the association between NF1 and GT. We report a case of a man aged 65 years, suffering from NF1, with intense pain at the thenar eminence of the right hand, successfully treated with the excision of the mass.
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Affiliation(s)
| | - Roberto Rossi
- Orthopedics and Trauma Clinic, Second University of Naples - Naples - Italy
| | - Stefano Artiaco
- U.O.C Muscoloskeletal Traumatology, U.O.D. Microsurgery, C.T.O. Hospital, Torino, Italy
| | - Giovanni Merolla
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica - AUSL della Romagna- Italy,Biomechanics Laboratory “Marco Simoncelli”, D. Cervesi Hospital, Cattolica - AUSL della Romagna – Italy,Corresponding author: Giovanni Merolla, MD, Unit of Shoulder and Elbow Surgery, “D. Cervesi” Hospital, AUSL della Romagna Ambito Territoriale di Rimini, L.V Beethowen 5, code:47841 Cattolica - Italy, phone: +39 0541 966382 - fax: +39 0541 966312, e mail:;
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Zreik N, Talbot C, Peach C. Glomus tumour of the elbow: a case of mistaken identity. Shoulder Elbow 2014; 6:134-6. [PMID: 27582928 PMCID: PMC4935074 DOI: 10.1177/1758573214522019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 01/10/2014] [Indexed: 11/17/2022]
Abstract
Glomus tumours are small vascular tumours that are usually benign and rarely occur. However, atypical locations of these tumours can lead to misdiagnosis, particularly where the lesion is rarely reported. We report a case of glomus tumour located on the posterior aspect of the elbow, which was mistaken for, and treated as the commonly diagnosed, olecranon bursitis for several years. With worsening symptoms, mainly pain, pinpoint tenderness and hypersensitivity, the patient was referred for a further opinion, and the lesion was diagnosed as a glomus tumour following complete excision under anaesthesia. This present case highlights the importance in considering this rare entity in the differential diagnosis of posterior elbow swelling and pain. Furthermore, this report provides a review of the literature and identifies the need for early specialist referral to confirm diagnosis, alleviate patient symptoms and improve function.
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Affiliation(s)
- Nasri Zreik
- Royal Bolton Hospital NHS Foundation Trust, Bolton, Lancashire, UK
| | - Christopher Talbot
- Royal Bolton Hospital NHS Foundation Trust, Bolton, Lancashire, UK,Christopher Talbot, Royal Bolton Hospital NHS Foundation Trust, Minerva Road, Farnworth, Bolton, Lancashire BL4 0JR, UK. Tel.: +44 1204390738. Fax: +44 1204390344. E-mail:
| | - Chris Peach
- University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
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