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Eighteen patients with a glomus tumor in the hand are reviewed. in five cases the tumor was subjected to light and electron microscopical analysis. This unusual lesion is often quite debilitating. the major symptoms are intense pain with mechanical stimulation of the tumor and temperature hypersensitivity. Careful dissection and complete removal of...
Citations
... It is reported to have a sensitivity of 23% to 38% and a specificity of 90% [9]. The mechanism of pain seems to be associated with the contraction of myofilaments in response to temperature changes, due to increased intracapsular pressure [29]. ...
Purpose:
Glomus tumors account for 1-4% of benign hand tumors. In 65% of cases, it is located in the nail bed. Its rarity makes misdiagnosis problems relatively common. Symptomatology is characterized by the hallmark symptomatic triad. Imaging investigations may guide the diagnosis, but the diagnosis is made by pathological examination doubled by immunohistochemical (IHC) markers.
Patients, materials and methods:
We studied a group of seven female patients, aged 28 to 56 years. Clinical examination revealed the presence of the characteristic symptomatic triad. Ultrasound imaging tests were performed.
Results:
Anatomopathological examination made a diagnosis of glomus tumor in all seven cases. IHC staining showed that tumor cells were positive for alpha-smooth muscle actin (α-SMA) and h-caldesmon in all seven cases and negative for cluster of differentiation 34 (CD34) in 72.14%. IHC stainings for p63, S100, cytokeratin (CK) AE1∕AE3 were negative in all cases. The clinical diagnosis completed by ultrasonography was histopathologically confirmed in all cases.
Conclusions:
Although the glomus tumor is a rare lesion, we need to be familiar with it because a diagnostic delay also implies a treatment delay which will lead to amplified suffering and even real disability due to the high-intensity pain in these cases.
... In all cases, the treatment is surgical and is based on complete excision. Recent work shows that recurrences are not uncommon [2,3]. ...
... Recent work shows that recurrences are not rare, according to the authors, 4 to 24% of patients require a new intervention [2,3], however recent literature indicates that the rate of recurrence can reach 50% [10]. Early recurrence (less than a year) is considered to be the result of incomplete excision [3] or the presence of a second tumor that was not diagnosed and excised during the first intervention [11]. ...
Glomus tumors of the hand are benign vascular tumors, which develop at the expense of the neuro-myo-arterial glomus. They represent about 1% -5% of all hand tumors. Their diagnosis is frequently delayed by the absence of specific signs, its confirmation is based on anatomopathological examination. Their treatment is based on complete surgical excision and restitution of the nail apparatus, the only guarantees of a good evolution without recurrence. We report the case of a recurrence of a glomus tumor of the ring finger in a woman where the pains reappeared 6 months after the first intervention.
... The modified smooth muscle cells of the glomus body are involved in temperature regulation [7] . Although the exact etiology of glomus tumor is still unknown, it is suggested that it arises from a structure weakness in a glomus body [1,8] . Glomus tumor most commonly reported in literature in the fingertips and it is proposed to be related to multiple factors such as sex, age, trauma, or inheritance [9,10] . ...
... [3] This diagnosis can be difficult to make and patients may suffer from this condition for years before resolution. [4] When the diagnosis of glomus tumor is suspected, some clinicians feel it necessary that the diagnosis is backed by imaging modalities. Radiographs fail to detect these lesions in up to 50% of cases. ...
... Radiographs fail to detect these lesions in up to 50% of cases. [4] Other modalities such as ultrasound, [5] magnetic resonance imaging, [6] dynamic thermography, [7] transillumination, [8] and others have been utilized as well. A meticulous complete surgical excision is the only recommended treatment. ...
... The mechanism of pain in glomus tumors has not been fully established, and several studies have suggested multiple mechanisms. The connective tissue capsules surrounding the tumors often contain bundles of myelinated and unmyelinated nerve fibers while the cytoplasm contains myofilaments resembling smooth muscle cells [12]. Unmyelinated nerve fibers have also been discovered in the tumor parenchyma [13]. ...
Glomus tumors are a rare, benign neoplasm and 75% exist in the subungual region. Extradigital glomus tumors are much more difficult to diagnose because of their atypical location and symptoms. Furthermore, if their symptoms are similar to neuropathic pain, the patient can suffer from misdirected treatment due to misdiagnosis. It is essential to perform careful evaluation of the lesion itself in order to reduce misdiagnosis. Ultrasonography is a useful, non-invasive method that can be easily performed in the pain clinic for local evaluation and diagnosis. We report a case of misdiagnosed glomus tumor in the thigh which was properly diagnosed after ultrasonography.
... Importantly, extradigital cases account for 11-65% of all glomus tumor cases and have been reported to be more common in men, although most subungual lesions occur in women [3,9,11]. The etiology of a glomus tumor is not clear, although an autosomal dominant pattern of inheritance and a history of injury have been reported [12,13]. We present the case of a woman who had no family history of a relevant glomus tumor and no history of injury; chronic pain and focal tenderness were alleviated after surgical removal of an extradigital forearm glomus tumor. ...
Introduction. A glomus tumor is a benign vascular tumor derived from glomus cells and occurs mainly in the subcutaneous layer of the subungual or digital pulp. Extradigital glomus tumors have been reported within the palm, wrist, forearm, foot, bone, stomach, colon, cervix, and mesentery. Glomus tumors can originate from the intraosseous, intramuscular, periosteal, intravascular, and intraneural layers. However, a glomus tumor originating from the intravascular layer of the forearm is a rare condition. Case Report. A 44-year-old woman had a 7-year history of chronic pain and focal tenderness of the forearm. No hypersensitivity or sensory alterations were observed. Contrast magnetic resonance imaging (MRI) showed a mass measuring 5 × 3 × 2 mm leading to a vein. Surgical excision was performed, and the tumor was completely resected. Finding of gross examination revealed a dark-red, well-defined soft tissue tumor, and histologic examination confirmed that the mass was a glomus tumor. The patient's symptoms were completely resolved postoperatively. Conclusion. Intravascular glomus tumors rarely occur in the forearm; therefore, a thorough physical exam, comprehensive medical history, in-depth imaging, and early surgical excision upon clinical suspicion may be helpful to prevent a delayed or incorrect diagnosis.
... Les récidives ne sont pas rares, 4 à 24 % des patients nécessitant une nouvelle intervention [10,12,23,24]. La reprise n'est pas toujours facile en raison de la fibrose du lit unguéal séquellaire des interventions précédentes et de la difficulté de différencier le tissu normal et le tissu tumoral, même avec les techniques microchirurgicales (grossissement optique). ...
We report the cases of two women aged 28 and 34years who presented recurrent glomus tumors of the hand after surgery for marginal resection of the tumor mass. The pathological study of the surgical specimen confirmed the diagnosis of recurrent glomus tumor. Due to the vascular origin of this tumor, sclerotherapy was delivered. The functional outcomes were good with dramatic pain relief within a few days. At 3-year mean follow-up, the cosmetic and functional results were very satisfactory.
... El índice de recidiva de los tumores glómicos intraóseos tras la escisión quirúrgica es desconocido, para los tumores de partes blandas oscila entre el 5% y el 50%. [9][10][11][12] Se los puede clasificar en solitarios o múltiples, según el número de lesiones tumorales. Las recidivas pueden clasificarse en tempranas o tardías. ...
... Most authors assumed that recurrence is due to inadequate excision, promoting some to recommend more extensive en bloc excision. Regardless of which approach is used, recurrence rates in the digits range from 5%-50% [ Delayed "recurrence" is possibly due to the development of a new glomus tumor near the excision site [16,29,38,39]. In some series, the number of patients with early recurrence was nearly equal to the number of patients with delayed recurrence, with a slight predominance of early recurrences (54%) [28]. ...
... Early recurrences can be attributed to incomplete excision (4,16) or to the presence of a second tumor that was not previously diagnosed and excised during the initial operation (22,23). Delayed "recurrence" is possibly due to the development of a new glomus tumor near the excision site (17,18,24,25). In our series, the number of patients with early recurrence was nearly equal to the number of patients with delayed recurrence, with a slight predominance of early recurrences (54%). ...
To determine the magnetic resonance (MR) imaging findings in recurrent glomus tumors of the fingertips.
Twenty-four consecutive patients with recurrent pain after previous excision of a glomus tumor of the fingertip underwent MR imaging studies and surgery. T1-weighted spin-echo MR images were obtained in each patient before and after intravenous injection of contrast material; T2-weighted spin-echo and three-dimensional gradient-recalled echo images were also obtained. MR angiography was performed in four patients. Postsurgical histopathologic analysis revealed recurrent glomus tumors in 22 patients. Signal intensity, enhancement, and margins of the scar tissue and the recurrent tumors at MR were assessed.
The postsurgical scars were depicted in 21 (88%) of 24 patients with all sequences but were best demonstrated on gradient-recalled echo MR images. Seven patients had undergone multiple surgical procedures and had extensive scar tissue and, in one case, a neuroma. In all patients, MR imaging revealed a nodule compatible with the diagnosis of a recurrent glomus tumor. In 13 (54%) of 24 patients, the nodule had typical features of a glomus tumor. In eight (33%) of 24 patients, the tumors had low signal intensity or isointensity compared with the nail bed on T2-weighted images. In six (25%) of 24 patients, the tumors had faint enhancement after intravenous gadolinium chelate administration. The margins of the tumors were blurred by scar tissue in nine of 24 cases.
MR imaging can aid in the evaluation of recurrent glomus tumors.
