Glomus tumour: an institutional experience of 31 cases

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Genotype-phenotype associations in paragangliomas of the temporal bone in a multi-ethnic cohort

BACKGROUND

Temporal bone paragangliomas are rare tumours with variable presentation that can be hereditary. Identification of clinical and genetic factors of aggressive tumour behaviour is important.

OBJECTIVE

To determine the underlying genetic mutations and genotype/phenotype correlations in a multi-ethnic population of South Florida with sporadic temporal bone paragangliomas.

METHODS

In a cohort of glomus tympanicum (GT) and glomus jugulare (GJ) cases, we assessed the frequency of pathogenic single nucleotide variants, insertions, deletions, and duplications in coding exons of genes that have been associated with paragangliomas (SDHB, SDHC, SDHD, SDHA, SDHAF2, RET, NF1, VHL, TMEM127, and MAX).

RESULTS

None of the 12 GT cases had mutations. Among 13 GJ cases, we identified four mutation carriers (31%); two in SDHC, one in SDHB, and one in SDHD. All patients with pathogenic mutations were of Hispanic ethnicity, presented at a younger age (mean 27.5 versus 52.11 years), and with more advanced disease when compared to mutation-negative GJ cases.Conclusions and Significance: Mutations in the SDH genes are found in 31% of sporadic GJ. SDH-associated GJ had advanced disease and a 50% risk of metastasis. Our data supports emerging recommendations for genetic screening in all populations with GJ tumours as the genetic status informs management.

Glomus tumour of the nipple in a male patient

A glomus tumour is a benign mesenchymal tumour. It is extremely rare in the breast. We report a case of glomus tumour of the nipple in a 54-year-old man. To the best of the authors' knowledge, this is the first case report of a glomus tumour of the nipple. We describe the different presenting symptoms, method of diagnosis and treatment.

CT angiography and MRI of hand vascular lesions: technical considerations and spectrum of imaging findings

Vascular lesions of the hand are common and are distinct from vascular lesions elsewhere because of the terminal vascular network in this region, the frequent hand exposure to trauma and microtrauma, and the superficial location of the lesions. Vascular lesions in the hand may be secondary to local pathology, a proximal source of emboli, or systemic diseases with vascular compromise. In most cases, ischaemic conditions are investigated with Doppler ultrasonography. However, computed tomography angiography (CTA) or dynamic contrast-enhanced magnetic resonance angiography (MRA) is often necessary for treatment planning. MR imaging is frequently performed with MRA to distinguish between vascular malformations, vascular tumours, and perivascular tumours. Some vascular tumours preferentially affect the hand, such as pyogenic granulomas or spindle cell haemangiomas associated with Maffucci syndrome. Glomus tumours are the most frequent perivascular tumours of the hand. The purpose of this article is to describe the state-of-the-art acquisition protocols and illustrate the different patterns of vascular lesions and perivascular tumours of the hand.

Glomus tumour of the iris: A case report

INTRODUCTION

Glomus tumours are rare benign tumours formed by modified smooth muscle cells arising from the glomus body. Glomus tumours occurring in the iris have not been previously reported.

CASE DESCRIPTION

A 32-year-old woman presented with a 9-day history of blurred vision in her right eye. Ultrasound, computed tomography and magnetic resonance imaging confirmed the presence of a mass lesion within the iris. Surgery of the iris was performed and the tumour was removed. Histopathological analysis confirmed a glomus tumour. The patient remains clinically stable 5 months following surgery and has experienced no tumour recurrence.

CONCLUSION

The findings from this case suggest that the typical symptoms of a glomus tumour may be absent in some cases, and that imaging examinations can help in understanding the extent of the lesion and the involvement of adjacent structures. Moreover, pathology and immunohistochemistry are crucial to confirm the diagnosis.

Primary glomus tumour of the pituitary gland: diagnostic challenges of a rare and potentially aggressive neoplasm

Primary non-neuroendocrine tumours of the pituitary gland and sella are rare lesions often challenging to diagnose. We describe two cases of clinically aggressive primary glomus tumour of the pituitary gland. The lesions occurred in a 63-year-old male and a 30-year-old female who presented with headache, blurred vision and hypopituitarism. Neuroimaging demonstrated large sellar and suprasellar tumours invading the surrounding structures. Histologically, the lesions were characterised by angiocentric sheets and nests of atypical cells that expressed vimentin, smooth muscle actin and CD34. Perivascular deposition of collagen IV was also a feature. Case 2 expressed synaptophysin. INI-1 (SMARCB1) expression was preserved. Both lesions were mitotically active and demonstrated a Ki-67 labelling index of 30%. Next-generation sequencing performed in case 1 showed no mutations in the reading frame of 37 commonly mutated oncogenes, including BRAF and KRAS. Four pituitary glomus tumours have previously been reported, none of which showed features of malignant glomus tumour. Similar to our two patients, three previous examples displayed aggressive behaviour.

The 'shark mouth' flap approach for digital glomus tumours in 24 patients: technique and clinical outcomes

This retrospective, single-centre study was carried out on patients with digital subungual glomus tumours. We describe a subperiosteal approach with a 'shark mouth' flap containing the nail plate and nail bed as a single unit, providing ideal exposure and easy access to the tumour. It combines the advantages of the transungual and lateral approaches, whether the subungual tumours are located centrally, peripherally or under the germinal matrix. The 'shark mouth' flap approach was used by the same surgeon in 24 patients with solitary glomus tumours of the fingers. Clinical outcomes at the early postoperative phase and at the last follow-up were satisfactory. Pain relief and wound healing were quickly achieved. No complications, such as fingertip numbness or nail deformities, were observed, and there was only one recurrence. This approach is reliable, nail-sparing and less time-consuming than other techniques. Level of evidence: IV.

Glomangioma: rare case of a painful lump in the upper lip

Glomus tumours in the lip are extremely rare with only 13 cases, including this one, recorded in the English language that we know of. We report a 45-year-old woman with a firm, mildly painful lump in her upper lip. Excisional biopsy examination and histopathological analysis showed it to be a subtype of glomus tumour called a glomangioma.

Glomangiopericytoma-type glomus tumour/myopericytoma of the lip

We describe the case of a 46-year-old man who presented with a four-month history of a reddish, otherwise asymptomatic, nodular lesion that involved the mucosal side of the upper lip. The lesion consisted of myoid glomus-like cells arranged around branching and thin-walled haemangiopericytoma-like vascular structures, and was classified as glomangiopericytoma. No recurrences occurred during an eight-month follow-up. To the best of our knowledge, this tumour has never previously been described in the mucosa of the lip.

Cutaneous malignant glomus tumours: applicability of currently established malignancy criteria for tumours occurring in the skin

Glomus tumours (GTs) have traditionally been classified into benign GTs, GTs with uncertain malignant potential and malignant GTs, based on a combination of criteria such as size of the tumour, degree of nuclear atypia and the level of mitotic activity. Several of the proposed grading criteria are difficult, or even impossible to apply for GTs occurring in the skin. The aim of the study was to analyse the applicability of the currently established GT malignancy criteria for tumours occurring in the skin and to establish their prognostic significance. A total of 25 benign cutaneous GTs, 11 new cutaneous malignant GTs and 36 cutaneous malignant GTs previously published in the literature were studied. We analysed the following clinicopathological features and correlated them with disease outcome: age, sex, site, size, depth of invasion, degree of nuclear atypia, mitotic activity, growth pattern, vascular invasion, spindle-cell morphology and tumoural necrosis. Of all the clinicopathological parameters analysed, only tumoural necrosis was found by univariate analysis (p = 0.001) to be associated with adverse biological behaviour, and none by multivariate analysis. Multivariate statistical analysis failed to detect any clinicopathological features predictive of the disease outcome (e.g., local recurrence, development of metastatic spread and/or death of disease) in cutaneous malignant GTs. Furthermore, the currently established malignancy criteria for cutaneous GTs can be difficult to apply, mainly due to their smaller size. Likewise, counting mitotic activity per 50 high power fields can often not be accomplished in GTs occurring at superficial locations. Complete excision of these tumours coupled with long-term follow-up is the mainstay of treatment for cutaneous malignant GTs. The results of our study also suggest that cutaneous malignant GTs follow a more indolent clinical course than their deep soft tissue counterparts.

Factors affecting surgical outcomes of digital glomus tumour: a multicentre study

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.

Glomangiomyoma of the neck in a child in Nepal: a rare case report and literature review

Background

Glomangiomyoma is a rare histological variant of glomus tumour. Clinically, it mimicks as a haemangioma and is challenging to diagnose. Its occurrence in the neck of a child has not been previously described.

Case presentation

A 3 year old girl presented with the complaints of painless progressive neck swelling in the right side for one and half year. Sonography, computed tomography (CT), magnetic resonance imaging (MRI), CT neck angiography and fine needle aspiration cytology (FNAC) were suggestive of vacular malformation i.e. giant haemangioma or arteriovenous malformation. The mass was removed in toto under general anaesthesia without postoperative complications. The histopathology confirmed it to be glomangiomyoma with haemangiopericytoma like features.

Conclusion

It's an extremely rare variant of glomus tumour and may be the first report of a glomangiomyoma in the neck of a child. Despite a rare entity, it should be borne in mind during differential diagnosis.

Gastric glomus tumor: clinical conundrums and potential mimic of gastrointestinal stromal tumor (GIST)

Gastric glomus tumor is a rare neoplasm of the gastrointestinal tract that frequently mimics other mesenchymal lesions clinically and radiologically. We present a 70-year-old woman with an incidentally detected submucosal tumor of the antrum that was thought to be a gastrointestinal stromal tumor (GIST). The lesion measured 1.9 cm radiographically and was monitored over a period of 3 years. Multiple biopsies were attempted but did not yield a clear diagnosis. Over time, the lesion increased in size and developed an area of ulceration, prompting a wedge resection. After surgery, a diagnosis of glomus tumor was reached on the basis of histological and immunohistochemical studies. Glomus tumors are neoplasms of perivascular smooth muscle differentiation that can occur nearly anywhere in the body but exhibit a strong predisposition for the skin and subcutaneous tissue. They usually follow an indolent clinical course, although rare cases of metastasis have been reported. Gastrointestinal involvement is uncommon, and when present, the stomach is almost exclusively involved. Preoperative diagnosis may be impossible given the overlapping features with other mesenchymal tumors of the stomach, as illustrated in our case. A literature review of 210 gastric glomus tumors is provided, and important diagnostic pitfalls are highlighted to prevent misdiagnosis. In an era of precision medicine where incidental lesions are increasingly detected by routine endoscopy and imaging, awareness of this rare entity is important, as gastric glomus tumors are generally benign with a favorable prognosis following complete resection.

Acquired Solitary Glomangiomyoma on the Forearm: A Rare Case Report

Glomus tumours are benign lesions which are frequently seen on hand (particularly subungual region). In this report a 52-year-old male patient with glomangiomyoma on the left forearm has been presented. With a preliminary diagnosis of haemangioma, a subcutaneous well-circumscribed nodular lesion of the patient was excised. On histomorphological examination glomus cells, vascular structures and spindle-shaped smooth muscle cells were seen around it. Immunohistochemistry of smooth muscle cells and glomus cells showed positivity for smooth muscle actin. By means of these findings, the patient was diagnosed with glomangiomyoma. Glomus tumours are rare in the forearm (In the literatüre there are two cases). Moreover, glomangiomyomas are the least common histomorphological type of glomus tumour and are generally seen in the lower extremity. In the literature, a few cases of glomangioma and solitary glomus tumour has been described on the forearm histologically and only a few glomangiomyoma cases on forearm location. We have presented the glomangiomyoma on the forearm as a rarely-seen case. Early diagnosis of the glomangiomyoma on the forearm is of importance for the prevention of morbidity.

Glomus tumour

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

Glomus tumours of the hand: Review of literature

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.

[Glomus tumour of the lung: a case report and literature review]

BACKGROUND

Glomus tumours are neoplasms arising from cells of the neuromyoarterial glomus bodies, which almost always occur in a subungual location. A lung location is extremely rare, with few cases reported in the literature.

CLINICAL CASE

The case is presented of a 33 year-old male, with non-productive cough, dyspnoea at rest, intermittent fever, and mild pain in rib cage. A chest radiograph showed a consolidation in the left lung, and computed tomography revealed a lesion in the hilum that extended to the bronchus of the lingula obstructing, and causing post-obstructive pneumonia. A biopsy was obtained by rigid bronchoscopy biopsy, which showed a well circumscribed tumour constituted by intermediate-sized cells, and abundant cytoplasm that are arranged in a pattern surrounding numerous thin-walled blood vessels, with no pleomorphism, significant mitotic activity or necrosis. Immunohistochemistry revealed diffuse positivity with smooth muscle actin, vimentin, caldesmon; focal reactivity with desmin and CD117, CD34 highlights the vascular pattern. Ki67 proliferation rate was 1%. Synaptophysin, EMA and cytokeratin cocktail were negative, making the diagnosis of glomus tumour.

CONCLUSIONS

Glomus tumours are rare neoplasms that usually appear in the dermis and subcutaneous tissue, where it is common to find glomus bodies. Occasionally glomus tumours can occur in extra-cutaneous sites such as the gastrointestinal tract, bone and respiratory system, with this case being a new case of rare lung location.

Nail-preserving modified lateral subperiosteal approach for subungual glomus tumour: a novel surgical approach

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.

A rare submucosal tumour of stomach-glomus tumour: A case report

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Rare submucosal tumour of stomach.

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Incidence 1 in 100 gastrointestinal stromal tumour.

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Preoperative diagnosis is difficult.

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Immunohistochemistry gold standard tool for confirmation.

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Wedge resection is the treatment of choice.

Introduction

Glomus tumour (GT) of the stomach is a rare submucosal mesenchymal tumour. Gastric glomus tumours are clinically recognized as benign. Nevertheless, some show biological behaviour similar to that of malignant lesions and presurgical confirmation is often impossible.

Presentation of case

A 32 year old female who presented with epigastric pain and was subsequently investigated for a antral tumour of the stomach and Wedge resection of tumour was done. Immunohistochemistry demonstrated strong positivity of smooth muscle actin and vimentin with low rate of mitosis studied by ki-67.

Discussion

We discuss the preoperative investigation, the diagnostic problems and the surgical treatment of the patient with gastric glomus tumour.

Conclusion

Glomus tumours should be considered as differential diagnosis for submucosal tumours of stomach.

Glomus tumour of the colon: dynamic contrast-enhanced CT findings and review of the literature

We describe the peculiar enhancement pattern of a subepithelial colonic glomus tumour on dynamic contrast-enhanced computed tomography. Discontinuous, peripheral nodular enhancement of the colonic lesion followed by subsequent centripetal filling-in of contrast was reminiscent of a hepatic haemangioma, which has not been described with a glomus or any other subepithelial tumour of the colon. When encountered, this tumour enhancement pattern raises the possibility of a colonic glomus tumour prior to histological confirmation.

Glomus tumour of the elbow: a case of mistaken identity

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.

Subungual glomus tumours: diagnosis and microsurgical excision through a lateral subperiosteal approach

Digital glomus tumour is a rare neoplasm. Surgical excision is the only known curative treatment but the best approach for subungual glomus tumours is still controversial. A total of 12 patients with subungual glomus tumour were reviewed. There were 11 female patients and one male patient, with a mean age of 48.6 years. Surgical procedures were performed using an operative microscope and tumours were excised using the lateral subperiosteal approach. In all, 10 patients were satisfied with the outcome from the lateral operative approach because they were able to use the affected hand for kitchen work shortly after the treatment. One case presented residual tumour and underwent re-operation. No tumour recurrences and nail deformity were detected after excision with the lateral approach. The lateral subperiosteal approach was safe and reliable for the subungual glomus tumour and allowed full access to any glomus tumours. Microscopy allows careful visualisation of the tumour. It is important that surgeons accurately locate tumours to achieve complete excision.

Atypical presentation of a glomus tumour: A case report

A 46-year-old man presented with an extremely painful, 1 cm, mobile, nodular mass located on the medial side of his right elbow. Symptoms failed to respond to conservative treatment. Ultrasound and Doppler flow imaging revealed a well-defined, round hypoechoic mass. Under local anesthesia, the mass was resected and the wound closed without complication. Final pathology diagnosed the lesion as a glomus tumour, solid type. Histology staining showed the tumour cells were positive for antibodies to vimentin and muscle actin. It is unusual for a glomus tumour to be located anterior to the medial epicondyle of the right arm. Hand surgeons most commonly encounter glomus tumours in the nailbeds of the fingers.

Capillary haemangioma of the middle ear: a rare lesion difficult to evaluate

Haemangiomas are benign vascular tumours relatively common in the head and neck district but very rare in the temporal bone. Depending on its clinical presentation, haemangioma can be mistaken for other vascular masses such as glomus tumour or other lesions of the middle ear. Unfortunately, clinical and radiological evaluation may be insufficient to make a pre-operative diagnosis and the diagnosis is often based upon intra-operative biopsy specimen findings.