Multiple blue papules. Hereditary glomangiomas

Glomangioma of Uncertain Malignant Potential: A Case Report

Glomus tumors are rare benign tumors which commonly affect the hand but are seldom seen extradigitally. Less commonly seen is the glomangioma, a variant of benign glomus tumor, and even rarer is the glomangiosarcoma, a malignant variant. Determining malignancy can be difficult and an intermediate diagnosis, glomus tumor of uncertain malignant potential, has been proposed. We present a case of a 56-year-old male with a recurrent forearm mass diagnosed as a glomangioma of uncertain malignant potential. Although the characteristics and behavior of malignant cases are still incompletely understood, it is important that a high index of suspicion be maintained when approaching these tumors, especially when large or recurrent. Glomangiomas should be included in the differential diagnosis when evaluating soft tissue masses in the forearm and should be evaluated for malignant features.

Glomus tumor

Glomus tumor is a benign mesenchymal neoplasm comprising less than 2% of soft tissue tumors. It is composed of cells resembling modified smooth muscle cells of the normal glomus body. The glomus body, a thermoregulator, is a specialized form of arteriovenous anastomosis localized in dermal and precoccygeal soft tissue. Although glomus tumors are rare neoplasms, clinical misdiagnosis of many of these lesions as hemangiomas or venous malformations makes an accurate assessment of their actual prevalence difficult. A malignant counterpart of this lesion exists but is extremely rare.

The Glomangioma in the Differential Diagnosis of Vascular Malformations

Glomus tumors develop from a thermoregulatory unit called the glomus body which is found in high density within the digits of both the hands and feet. To note, even though less frequently, these tumors can present in extradigital locations. Usually it presents as a small, 1-cm bluish nodule. Glomangioma (multiple glomus tumors) is to be differentiated clinically from the more solitary glomus tumor on the basis of larger size and prominent vascular markings. Although glomangioma is described in literature, the major textbooks of plastic surgery fail to mention it. A report of an unusual case of a large glomangioma in the shoulder of a 13-year-old female is presented. Clinical picture, investigation, surgical treatment, and pathology of this lesion are discussed.

Hereditary multiple glomangiomas

Hereditary multiple glomangiomas are an interesting rare problem which can either present as multiple painful cutaneous lesions or, rarely, a cosmetic challenge due to site, size or number of lesions. It may also pose a diagnostic dilemma, which can only be settled by biopsy. Malignant change in glomangioma is extremely rare and only a few cases are well documented in literature. A case report of this condition, along with extensive review of the literature, is presented. The prognosis of various forms of glomangiomas and efficacy of diagnostic and therapeutic tools is discussed.