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Mohamed MB, Idris M, Bibawy S. Intravascular Myopericytoma: A Case Report. Cureus 2022; 14:e28581. [PMID: 36185870 PMCID: PMC9521300 DOI: 10.7759/cureus.28581] [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] [Accepted: 08/30/2022] [Indexed: 11/22/2022] Open
Abstract
Myopericytoma is a rare tumor that arises from perivascular myoid cells. Intravascular myopericytoma is an exceptionally rare subtype with a small number of cases reported. Here, we describe the case of a 31-year-old woman who presented with a lump on the dorsum of the right foot for nine months. Imaging indicated that the lesion is in close proximity to the dorsalis pedis vessels. Following surgical excision, the histological analysis revealed a benign neoplasm arising within a vein wall with features of vascular and pericytic differentiation. When using immunohistochemistry, the blood vessels were highlighted by the cluster of differentiation (CD) 31 and smooth muscle actin (SMA) with negative staining for pancytokeratins. These features led to the diagnosis of intravascular myopericytoma.
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Najd Mazhar F, Shoushtarizadeh T, Mirzaei A. Intravascular Glomus Tumor of the Wrist Causing Chronic Wrist Pain. J Hand Microsurg 2018; 10:113-115. [PMID: 30154627 PMCID: PMC6103760 DOI: 10.1055/s-0038-1626683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/23/2017] [Indexed: 10/17/2022] Open
Abstract
Glomus tumors are glomus body neoplasms that most commonly occur in the subungual areas of the hand, typically characterized by small nodules associated with localized tenderness, cold sensitivity, and excruciating paroxysmal pain. Extradigital glomus tumors can present a diagnostic challenge because they are rare and usually accompanied by nonspecific symptoms. Intravenous origin of the glomus tumor, especially in the wrist, is much rarer. The authors here report an intravenous glomus tumor of the wrist presented with atypical features such as insensitivity to cold and a history of long-term pain, which led to the misdiagnosis of the lesion as extensor tendonitis. Following the excision of the tumor mass, the patient's pain completely disappeared and no further pain was reported afterward. As a result, the authors suggest a more careful workup for the correct diagnosis of glomus tumors with such atypical manifestations. They also suggest considering intravenous glomus tumor in the differential diagnosis of a chronic wrist pain.
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Affiliation(s)
- Farid Najd Mazhar
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Shafa Orthopedic Hospital, Tehran, Iran
| | - Tina Shoushtarizadeh
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Shafa Orthopedic Hospital, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Shafa Orthopedic Hospital, Tehran, Iran
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An Extradigital Glomus Tumor of the Median Antebrachial Vein. J Hand Surg Am 2018; 43:88.e1-88.e4. [PMID: 28888573 DOI: 10.1016/j.jhsa.2017.07.025] [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: 03/21/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
Glomus tumors are benign vascular neoplasms that arise from specialized dermal arteriovenous anastomoses called glomus bodies. These tumors are most often found in the digital pulp and subungual region of the fingertips; however, a review of the literature suggests that extradigital glomus tumors may occur more often than is generally recognized. Although most extradigital glomus tumors arise within subcutaneous tissues, glomus tumors have occasionally been found within bones, nerves, and blood vessels. An intravascular glomus tumor of the forearm is a very rare occurrence and only a few cases have been reported in the literature. Here we describe a 55-year-old right-handed man with a 10-year history of exquisite tenderness and dysesthesia of his right proximal forearm. Surgical exploration revealed the presence of a mass arising from the median antebrachial vein, which was confirmed histologically to be a glomus tumor.
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Chim H, al-Qattan H, Valencia H, Brathwaite C, Price A, Grossman JAI. Intravenous Glomus Tumor Masquerading as Lateral Antebrachial Cutaneous Neuroma. Hand (N Y) 2017; 12:NP19-NP21. [PMID: 28344537 PMCID: PMC5349419 DOI: 10.1177/1558944716675296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Intravenous glomus tumors are extremely rare. Methods: We report a patient with an intravenous glomus tumor within a venous aneurysm misdiagnosed as a neuroma of the lateral antebrachial cutaneous nerve, based on clinical exam, electrodiagnostic studies, and findings on a magnetic resonance imaging neurogram. Results: After surgical resection, the patient's symptoms, including pain and localized hypersensitivity, totally resolved. Conclusions: This case illustrates 2 important points. First, unlike extradigital glomus tumors, magnetic resonance imaging is not reliable in diagnosing intravenous glomus tumors. Second, in the presence of chronic localized neuroma type pain and sensitivity in the upper limb without a clear cause, an extradigital cutaneous or intravenous glomus tumor must be considered in the differential diagnosis.
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Affiliation(s)
- Harvey Chim
- University of Miami, FL, USA,Harvey Chim, Division of Plastic Surgery, University of Miami Miller School of Medicine, Clinical Research Building, 1120 N.W. 14th Street, 4th Floor, Miami, FL 33136, USA.
| | | | | | | | - Andrew Price
- New York University, USA,Miami Children’s Hospital, FL, USA
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Muneer M, Alkhafaji A, El-Menyar A, Al-Hetmi T, Al-Basti H, Al-Thani H. Intravascular extra-digital glomus tumor of the forearm. J Surg Case Rep 2016; 2016:rjw124. [PMID: 27421300 PMCID: PMC4946538 DOI: 10.1093/jscr/rjw124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Intravascular glomus tumor in the forearm is very rare and usually presents with persistent pain and focal tenderness. The diagnosis of this condition can be easily missed or delayed. There is no successful treatment so far other than surgical excision in most of cases. We presented a 45-year-old female presented with intravascular glomus tumor in her left forearm. The swelling was excised and the post-operative course was uneventful. Intravascular glomus tumor of the forearm is extremely rare and the persistent pain and tenderness are very suspicious. Diagnostic imaging may not be indicated in every case.
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Affiliation(s)
- Mohammed Muneer
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ali Alkhafaji
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Talal Al-Hetmi
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Habib Al-Basti
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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6
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Multiple glomus tumors presenting as an aesthetic abnormality. Aesthetic Plast Surg 2015; 39:236-9. [PMID: 25673571 DOI: 10.1007/s00266-015-0453-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
Abstract
UNLABELLED Glomus tumors are benign soft-tissue neoplasms. Commonly found in the digits, glomus tumors can rarely arise in extradigital locations and may result in misdiagnosis or delay in diagnosis. Plastic surgeons should therefore include glomus tumors in the differential diagnosis of patients who present with painful, red- or blue-colored extradigital lesions. The authors present a rare case of extradigital glomangioma tumors of the right and left thigh in a 35-year-old woman. This case report describes an atypical presentation of multiple glomus tumors and reviews diagnostic and treatment modalities. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Valero J, Salcini JL, Gordillo L, Gallart J, González D, Deus J, Lahoz M. Intravascular myopericytoma in the heel: case report and literature review. Medicine (Baltimore) 2015; 94:e642. [PMID: 25789958 PMCID: PMC4602481 DOI: 10.1097/md.0000000000000642] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Intravascular myopericytoma (IVMP), regarded as a variant of myopericytoma, is a rare tumor. Very few cases have been described, none in the foot.The first case of IVMP located in the heel of the foot is described in this article. A literature review is reported of all cases of IVMP published in the English literature.A 48-year-old man possessed an IVMP on the heel of the right foot. The physical examination and histopathological and ultrasound studies are described. The literature review yielded 5 cases of IVMP, 2 of which were in the thigh and 1 each in the oral mucosa, the periorbital region, and the leg.The possibility that these lesions may be malignant suggests that the histopathological study of vascular tumors should include immunohistochemical tests.
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Affiliation(s)
- José Valero
- From the Department of Human Anatomy and Histology (ML, JV, JG, DG), Department of Surgery (JD), Zaragoza University, Zaragoza, Spain; Department of Podiatry (JLS, LG), Sevilla University, Sevilla, Spain
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Intravascular glomus tumor of the forearm causing chronic pain and focal tenderness. Case Rep Orthop 2014; 2014:619490. [PMID: 24624306 PMCID: PMC3929381 DOI: 10.1155/2014/619490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/22/2013] [Indexed: 11/18/2022] Open
Abstract
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.
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Schoenleber SJ, Rosenberg AE, Temple HT. Painful forearm mass in a 75-year-old man. Clin Orthop Relat Res 2014; 472:776-80. [PMID: 24307065 PMCID: PMC3890184 DOI: 10.1007/s11999-013-3409-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/22/2013] [Indexed: 01/31/2023]
Affiliation(s)
- Scott J. Schoenleber
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, University of Miami, 1400 NW 12th Avenue, Room 4036, Miami, FL 33136 USA
| | | | - H. Thomas Temple
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, University of Miami, 1400 NW 12th Avenue, Room 4036, Miami, FL 33136 USA
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Intravascular extension of a glomus jugulare. Otol Neurotol 2013; 34:e125-7. [PMID: 24080975 DOI: 10.1097/mao.0b013e318292fb53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nigam JS, Misra V, Singh A, Karuna V, Chauhan S. A glomus tumour arising from the flexor aspect of the forearm: a case report with review of the literature. J Clin Diagn Res 2013; 6:1559-61. [PMID: 23285458 DOI: 10.7860/jcdr/2012/4233.2561] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 08/25/2012] [Indexed: 11/24/2022]
Abstract
A 45 year old male patient presented with the complaint of a purplish nodular painful swelling on the flexor aspect of the left forearm of five years duration. A radiological examination of the lesion was not done prior to its excision. A biopsy was done and it was sent for a histopathological examination. The biopsied tissue was single, irregular, firm and globular, it measured 0.5 x 0.5cm in size and it was processed in two halves Its microscopic examination showed a well circumscribed area which comprised of sheets and nodules of monomorphic round cells with slightly vesicular, round nuclei and an acidophilic cytoplasm, amongst which were interspersed numerous blood vessels, many of which were dilated and congested, along with numerous lymphatic channels which were filled with lymph. Immunohistochemistry for SMA, CEA and CD 34 was advised, out of which only SMA turned out to be strongly positive and a final diagnosis of a Glomus tumour was made.
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Affiliation(s)
- Jitendra Singh Nigam
- Junior resident, Department of Pathology, M.L.N.Medical College Allahabad, U.P., India
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Jiga LP, Rata A, Ignatiadis I, Geishauser M, Ionac M. Atypical venous glomangioma causing chronic compression of the radial sensory nerve in the forearm. A case report and review of the literature. Microsurgery 2012; 32:231-4. [PMID: 22407591 DOI: 10.1002/micr.20983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 10/25/2011] [Accepted: 10/28/2011] [Indexed: 11/10/2022]
Abstract
Extrinsic chronic nerve compression induced by nonendothelium derived vascular tumors is a rare occurrence at the forearm level. We present a case of severe chronic compression of the radial sensory nerve (RSN) caused by an undiagnosed venous glomangioma. The tumor was excised with complete symptoms relief. In the presence of severe nerve compression syndromes in young age, without predisposing comorbidities, atypical extrinsic compression due to vascular tumors should be considered.
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Affiliation(s)
- Lucian P Jiga
- Division of Reconstructive Microsurgery, Department for Vascular Surgery, Victor Babes University of Medicine and Pharmacy, Piata Eftimie Murgu 2,Timisoara, Romania.
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George SMC, Morrison IK, Farrant PBJ, Coburn PR. Intravenous glomus tumour of the upper arm. BMJ Case Rep 2012; 2012:bcr.11.2011.5152. [PMID: 22665877 DOI: 10.1136/bcr.11.2011.5152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Glomus tumours are rare, benign tumours of the glomus body, most frequently located in the subungual region of digits, palms and soles, but they have been reported throughout the body. Our patient is a 65-year-old man who presented with a 3-year history of a very painful area on his left upper arm. The overlying skin was normal and there was no lesion to palpate, but the symptoms were very striking, warranting further investigation. An exploratory operation identified a prominent vein with a noticeable bulge in the vessel wall. The vein was ligated and excised. On dissection of the vein, a tumour was present within its lumen. Histological examination and immune profile of the tumour confirmed an intravascular glomus tumour. Following surgical excision, symptoms resolved.
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Affiliation(s)
- Susannah M C George
- Department of Dermatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
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White CP, Jewer DD. Atypical presentation of a glomus tumour: A case report. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2011; 14:237-8. [PMID: 19554142 DOI: 10.1177/229255030601400402] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Iliescu OA, Benea V, Georgescu SR, Rusu A, Manolache L. Multiple glomus tumors. J Dermatol Case Rep 2008; 2:24-7. [PMID: 21886707 DOI: 10.3315/jdcr.2008.1012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Accepted: 05/12/2008] [Indexed: 11/11/2022]
Abstract
BACKGROUND Solitary and multiple glomus tumors are vascular tumors arising from glomus cells. These two forms have distinct clinical and histopathological features, suggesting that they might have a different pathogenesis. The multiple form is less frequent than the solitary form. Its diagnosis and treatment are more problematic and often delayed. MAIN OBSERVATION We present the case of a 40-year-old patient, with a 20-year history of numerous non-tender disseminated blue papules. At the age of 30 years one of the lesions was excised and than regrew and became painful. The histological exam of the lesions was consistent with glomangioma, also known as glomus tumor. We performed surgical resection of the nodular and painful lesions. CONCLUSION The diagnosis of glomus tumor is easily suspected when the lesion is painful located in the subungual region. However, if the lesions are multiple and extradigitally located, the clinical diagnosis may be difficult and requires having in mind this differential diagnosis. Our case also shows that glomus tumors may regrow after excision in the same location.
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Affiliation(s)
- Olguta Anca Iliescu
- "Scarlat Longhin" Clinical Hospital of Dermatology and Venerology, Bucharest, Romania
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Koibuchi H, Fujii Y, Taniguchi N. An unusual case of a glomus tumor developing in a subcutaneous vein of the wrist. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:369-370. [PMID: 18446863 DOI: 10.1002/jcu.20493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Glomus tumors are benign tumors that originate in a neuromyoarterial glomus body and most commonly occur in the subungual regions. We present an unusual case of a glomus tumor in a subcutaneous vein of the dorsum of the wrist in a 65-year-old man and describe its gray-scale and power Doppler sonographic appearance, with a brief discussion of the clinical and histologic findings.
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Affiliation(s)
- Harumi Koibuchi
- Department of Clinical Laboratory Medicine, Jichi Medical University School of Medicine, Yakushiji 3311-1, Shimotsuke, Tochigi 329-0498, Japan
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Ide F, Obara K, Yamada H, Mishima K, Saito I. Intravascular myopericytoma of the oral mucosa: a rare histologic variant in an uncommon location. Virchows Arch 2007; 450:475-7. [PMID: 17265081 DOI: 10.1007/s00428-007-0368-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 12/25/2006] [Accepted: 01/02/2007] [Indexed: 11/24/2022]
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Schiefer TK, Parker WL, Anakwenze OA, Amadio PC, Inwards CY, Spinner RJ. Extradigital glomus tumors: a 20-year experience. Mayo Clin Proc 2006; 81:1337-44. [PMID: 17036559 DOI: 10.4065/81.10.1337] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To review a large series of extradigital glomus tumors in order to gain a better understanding of their presentation and provide guidelines to aid in their diagnosis and treatment. PATIENTS AND METHODS We performed a retrospective review of all extradigital glomus tumors seen at our institution during a 20-year period (1985-2005) to document the incidence of the classic triad of symptoms, the duration of symptoms, the contribution of imaging to making a definitive diagnosis, and the effectiveness of treatment. RESULTS Fifty-six different patients with extradigital glomus tumors presented as follows: glomus tumors in the hand (3), wrist (4), forearm (11), elbow (4), arm (4), shoulder (2), buttock (1), thigh (5), knee (10), leg (3), ankle (2), foot (2), back (1), nose (1), cheek (1), ear lobe (1), and trachea (1). Forty-eight patients presented with pain and localized tenderness, but only 1 patient presented with cold Intolerance. The average duration of symptoms was greater than 7 years, with most patients being evaluated previously and having their conditions misdiagnosed. Magnetic resonance imaging proved to be the most useful modality for localization of these lesions. Surgical resection was the definitive treatment and generally provided immediate and sustained pain relief. CONCLUSIONS Extradigital glomus tumors are not a rare subgroup of glomus tumors. Treatment outcomes are excellent, but misdiagnosis and delayed diagnosis are common. Improved guidelines regarding symptoms and diagnosis of these neoplasms may reduce the morbidity, ensuing chronic pain, and psychiatric consequences of delayed diagnosis or misdiagnosis.
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Abstract
Cutaneous vascular proliferations are a vast and complex spectrum. Many appear as hamartomas in infancy; others are acquired neoplasms. Some vascular proliferations are hyperplastic in nature, although they mimic hemangiomas, i.e., neoplasms. The vast majority of the vascular lesions are hemangiomas. Between the hemangiomas and frankly angiosarcomas, there is a group of neoplasms that are angiosarcomas, albeit ones of low grade histologically and, probably, biologically. The term "hemangioendothelioma" has been created to encompass these neoplasms. Vascular proliferations are, fundamentally, composed of endothelial cells. Some hemangiomas, however, contain also abundant pericytic, smooth muscle, or interstitial components, or a combination of them. These heterogeneous cellular components are present usually in hemangiomas. Some of the newly described vascular proliferations, however, are difficult to differentiate from some of the angiosarcomas. Others are markers, occasionally, of serious conditions such as Fabry's Disease (angiokeratoma) and POEM's syndrome (glomeruloid hemangioma). Kaposi's sarcoma continues to be an enigma. The demonstration of Herpes virus 8 in this condition raises doubt about its neoplastic nature. The demonstration of endothelial differentiation of its nodular lesions is tenuous and its true nature remains unresolved. While physicians have known about post-mastectomy angiosarcomas from the origin of the radical mastectomy, a new group of unusual vascular proliferations of the mammary skin are being defined. These lesions arise in the setting of breast-conserving surgical treatment with adjuvant radiation therapy. The incubation period is usually 3 to 5 years, in contrast with the 10, or more, in classical cases of post-mastectomy angiosarcoma. These lesions usually are subtle, both clinically and histologically, in contrast with the "classical," dramatic presentation of mammary angiosarcoma. The spectrum of findings ranges from "simple" lymphangiectasia-like vascular proliferations to unequivocal angiosarcomas. The pathogenesis of these lesions remains a mystery. There are very few clues that allow one to separate hemangiomas from angiosarcomas. The presence of heterologous cellular elements and, particularly, well-developed smooth muscle components tends to favor a hemangioma. Similarly, the presence of thrombosis usually supports hemangioma. Nevertheless, there are no unequivocal or reliable individual diagnostic criteria. A thorough knowledge of the different conditions and their differential diagnoses eventually leads to the proper diagnosis in most cases.
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Affiliation(s)
- Steven J Hunt
- Northern Pathology Laboratory, Iron Mountain, Michigan, USA
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Abstract
BACKGROUND Myopericytoma is a benign tumor composed of cells that show apparent differentiation towards putative perivascular myoid cells called myopericytes. It arises most commonly in the dermis or subcutaneous tissue of the extremities in adults. METHODS We describe a myopericytoma that was unusual in its intravascular location. RESULTS A 54-year-old man presented with a 10-year history of a painful slowly growing 1.5-cm nodule in the subcutaneous tissue of the thigh. Histologic examination of the excised lesion showed that is was entirely contained within the lumen of a vein. It was composed of a proliferation of myoid-appearing spindle cells, which were arranged in a striking concentric pattern around numerous blood vessels, in a manner that accentuated the vessel walls. This pattern is characteristic of myopericytoma. In some areas, fascicles of spindle cells, embedded in a myxoid stroma, bulged into the lumina of lesional vessels, reminiscent of myofibroma/myofibromatosis. Lesional spindle cells were diffusely positive for smooth muscle actin, focally positive for CD34 and were negative for desmin, cytokeratin, S100 protein, HMB-45 and CD31. CONCLUSION This case illustrates that myopericytoma can be entirely intravascular in its location.
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Affiliation(s)
- Máirín E McMenamin
- Department of Dermatopathology, St. John's Institute of Dermatology, St. Thomas' Hospital, London, UK
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Abstract
A 10-year-old female spayed domestic shorthaired cat presented with a subcutaneous tumor between the first and second phalanges of the left hind foot. Six months after excision, a similar tumor occurred on the medial aspect of the third phalanx of the same limb. Histologically, both tumors consisted of solid masses of spindle and round cells, many of which grew within endothelial-lined vessels. Tumor cells stained positively for smooth muscle actin and vimentin, but were negative for cytokeratin, S-100, desmin, synaptophysin, factor VIII-related antigen, and neuron-specific enolase. The diagnosis was dermal intravascular leiomyosarcoma.
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Affiliation(s)
- M C Jacobsen
- Department of Biomedical Sciences, Cornell University, Ithaca, NY 14853, USA
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Abstract
A 59-year-old man presented with a 6-year history of a 2-cm tender nodule on his left lateral elbow. Excisional biopsy led to the diagnosis of angioleiomyoma. However, unlike typical angioleiomyoma which demonstrate extravascular extension, this lesion demonstrated purely intravascular growth.
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Affiliation(s)
- F P Sajben
- Department of Dermatology, Naval Medical Center San Diego, California 92134-1005, USA
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Abstract
We describe an unusual dermal neoplasm with epithelioid morphology. A 44-year-old man presented with a solitary, tender, 4-mm nodule on the leg. Excisional biopsy showed several well-circumscribed dermal epithelioid tumor nodules, prominent vascularity, and smooth muscle differentiation. We suggest the term cutaneous epithelioid angioleiomyoma for this neoplasm. In a review of the literature, we found reports of two similar cases and a recent report describing five cutaneous epithelioid leiomyosarcomas. Cutaneous epithelioid angioleiomyoma represents a rare variant of dermal smooth muscle tumor and could represent the benign counterpart to the recently described epithelioid leiomyosarcoma of the skin.
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Affiliation(s)
- M P Heffernan
- Department of Dermatology, Stanford University School of Medicine, California, USA
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25
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Requena L, Sangueza OP. Cutaneous vascular proliferation. Part II. Hyperplasias and benign neoplasms. J Am Acad Dermatol 1997; 37:887-919; quiz 920-2. [PMID: 9418757 DOI: 10.1016/s0190-9622(97)70065-3] [Citation(s) in RCA: 236] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This second part of our review about vascular proliferations summarizes the clinicopathologic features of the cutaneous vascular hyperplasias and benign neoplasms. Hyperplasias comprise a heterogeneous group of vascular proliferations that eventually show a tendency to regression. Angiolymphoid hyperplasia with eosinophilia is included within the group of hyperplasias because of its historical denomination and its reactive nature, probably as a consequence of an arteriovenous shunt, although usually the lesions do not regress. Pyogenic granuloma, bacillary angiomatosis, intravascular papillary endothelial hyperplasia, and pseudo-Kaposi's sarcoma qualify as vascular hyperplasias because they regress when the stimulus that initiated them is removed. Benign neoplasms form a large group of hemangiomas with distinctive clinicopathologic characteristics, although some of them are of recent description and may produce diagnostic difficulties. We classified cutaneous benign vascular neoplasms according to their cell lineage of differentiation, for example, endothelial, glomus cell, and pericytic differentiation. Subsequent categories are established according to the size of the involved vessels (capillaries, venules and arterioles, or veins and arteries) or the nature of the proliferating vessels (blood or lymphatic vessels). Capillary and cavernous hemangiomas have been the terms classically used to name the most common variants of benign vascular neoplasms (i.e., infantile hemangiomas), but they are not the most appropriate denominations for these lesions. First, these names are not contrasting terms. Furthermore, most of the socalled "cavernous" hemangiomas are not hemangiomas (neoplasms) at all, but venous malformations. The most important conceptual issue is that, at any point in time, a particular hemangioma has its own histopathologic pattern throughout the depth of the lesion. For these reasons, we classified hemangiomas into superficial and deep categories. Some of the lesions reviewed have been recently described in the literature, and they may histopathologically mimic lesions of Kaposi's sarcoma; these include targetoid hemosiderotic hemangioma, microvenular hemangioma, tufted hemangioma, glomeruloid hemangioma, kaposiform hemangioendothelioma, spindle-cell hemangioendothelioma, and benign lymphangioendothelioma. In each of these lesions, we update and emphasize those clinical and histopathologic features that are helpful for differential diagnosis with lesions of authentic Kaposi's sarcoma in any of its three stages of development (patch, plaque, or nodule).
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Affiliation(s)
- L Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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26
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Abstract
We report a painful intravenous glomus tumor located in the right forearm of a 79-year-old woman. The tumor originated from the wall of a vein, protruded into its lumen and was completely excised. The largest dimension of the tumor occluding the vein was 14 cm. Tumor cells were characterized immunohistochemically by the presence of vimentin, alpha-smooth-muscle actin, and collagen IV. Intravascular spread of the glomus tumor is rare and has been described in the stomach and subcutaneous tissue. An entirely intravenous glomus tumor has been reported only three times. However, a huge intravenous growth as in our case appears never to have been reported. A review of the intravascular cases showed that the average age of presentation is 61.5 years (range 40-79 years) and the most frequent location is the forearm. Despite this intravascular growth, there is no evidence of aggressive clinical behavior, recurrence or metastasis. The pathologist must be aware of this variant of glomus tumor to avoid misdiagnosis and unnecessary additional treatments.
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Affiliation(s)
- E Acebo
- Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain
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27
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Hirose T, Hasegawa T, Seki K, Yang P, Sano T, Morizumi H, Tsuyuguchi M. Atypical glomus tumor in the mediastinum: a case report with immunohistochemical and ultrastructural studies. Ultrastruct Pathol 1996; 20:451-6. [PMID: 8883329 DOI: 10.3109/01913129609016348] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A case is reported of atypical glomus tumor occurring in the posterior inferior mediastinum of a 26-year-old woman complaining of severe back pain. The tumor was composed of atypical small, round tumor cells with scattered mitotic figures. In addition to sheet-like, diffuse proliferation of the tumor cells, some areas of the tumor contained small "glomoid" cells arranged in organoid and hemangiopericytomalike patterns. Immunohistochemically, many tumor cells were positive for muscle-type actins and a few cells were focally positive for desmin. Ultrastructural studies revealed smooth muscle features of tumor cells, that is, pinocytotic vesicles, external laminas, dense plaques, and occasional thin filaments with dense bodies. The patient remained well for 5 years and 4 months after the operation without additional radiation and chemotherapy. The tumor was diagnosed as an atypical, or low-grade malignant, glomus tumor morphologically. It seems important to recognize the presence of this type of tumor in sites other than extremities and to differentiate it from other malignant small, round cell tumors.
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Affiliation(s)
- T Hirose
- First Department of Pathology, University of Tokushima School of Medicine, Japan
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28
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Abstract
An intravenous glomus tumor occurring in a forearm vein is reported. The patient had a painful subcutaneous mass which was completely excised. This mass was a neoplasm which expanded the lumen of a vein and extended throughout its wall into the surrounding subcutaneous fat. The neoplasm consisted of sheets of rounded cells with a capillary stroma. The neoplastic cells were closely apposed to the capillary vessels and were positive for vimentin, smooth muscle actin and muscle specific actin. The cells were negative for desmin, factor VIII-related antigen, epithelial membrane antigen, cytokeratins, S-100 protein and chromogranin. This is the 2nd reported case of intravenous glomus tumor of the forearm. This unusual presentation may be due to intravascular extension by a cutaneous glomus tumor. The potential for intravascular growth by glomus tumor should be recognized by surgeons, dermatologists and pathologists.
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Affiliation(s)
- P B Googe
- Department of Pathology, University of Tennessee Medical Center, Knoxville 37920
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