Glomus tumor of the lip. A case report and immunohistochemical study

Glomus tumor in the buccal mucosa: A case report and review of the literature

Glomus tumors are rare benign neoplasms usually occurring in the upper and lower extremities. However, oral cavity involvement is rare, with only a few case reports. We present a 37-year-old male patient with a chief complaint of an exophytic lesion in the left buccal mucosa for one year referred to our center. At the time, he did not have any pain or lymphadenopathy. The patient underwent surgery using a high-power CO₂ laser. His histopathological examination revealed a glomus tumor. After 2 years of follow-up, no evidence of recurrence was detected. Glomus tumors should be taken seriously when patients have a painless exophytic bluish lesion in the buccal mucosa.

A Rare Case of Glomus Tumor on the Mucosal Surface of Lower Lip

Glomus tumors are mesenchymal neoplasms derived from glomus bodies with rare presentations in the oral cavity. Glomus tumors present as a purple or pink vascular nodule or papule, sized <1 cm, and imitate vascular neoplasms such as hemangiopericytoma or hemangioma. Glomus tumors represent less than 2% of all benign soft tissue tumors. Only 27 cases of benign glomus tumors with oral cavity involvement have been reported to date. The most-reported oral tumors involved the lips (54.2%), followed by hard palate, gingiva, tongue, and buccal mucosa. The mean age of presentation of the labial glomus tumors is 48.7 years, with no gender predilection, in contrast to the subungual site, which occurs more in females. The etiology of the glomus tumors remains unknown. Subungual glomus tumors present as stabbing pain, cold intolerance, and tenderness of the fingertips, whereas labial glomus tumors mostly present as a painless, small, and slow-growing lesion. Treatment is surgical resection of the tumor. The recurrence rate of labial glomus tumors is unclear. In this article, we present the case of a 62-year-old man with a 2-month history of painless, soft lump on the mucosal surface of the lower left lip. Excisional resection of the tumor was performed in the clinic, and the histopathologic finding was consistent with solid glomus tumor. At 1 year follow-up there was no recurrence.

Glomus Tumor of the Oral Cavity: Report of a Rare Case and Literature Review

Glomus tumor is a benign neoplasm composed of a perivascular proliferation of glomic cells that resembles the normal glomus body. Usually, it appears as a solitary, symptomatic small blue-red nodule, located in the deep dermis or subcutis of upper or lower extremities of young to middle-aged adults. Cases affecting the oral cavity are very rare, with only 23 well-documented cases reported in the English-language literature. Herein, we present a rare case of glomus tumor of the upper lip, and review the literature of cases involving the mouth.

Glomus tumor in the floor of the mouth: a case report and review of the literature

Background

Glomus tumors are rare benign neoplasms that usually occur in the upper and lower extremities. Oral cavity involvement is exceptionally rare, with only a few cases reported to date.

Case presentation

A 24-year-old woman with complaints of swelling in the left floor of her mouth for 6 months was referred to our institution. Her swallowing function was slightly affected; however, she did not have pain or tongue paralysis. Enhanced computed tomography revealed a 2.8 × 1.8 × 2.1 cm-sized well-defined, solid, heterogeneous nodule above the mylohyoid muscle. The mandible appeared to be uninvolved. The patient underwent surgery via an intraoral approach; histopathological examination revealed a glomus tumor. The patient has had no evidence of recurrence over 4 years of follow-up.

Conclusions

Glomus tumors should be considered when patients present with painless nodules in the floor of the mouth.

The glomus tumor resorbed bone and teeth in the mandible: a case report

BACKGROUND

A glomus tumor is a rare neoplasm usually found in the dermis or subcutaneous tissue of the extremities. It is rare for the glomus tumor to occur on the head and face. Only 26 glomus tumors of the oral region and affected bone have been reported in the English-language literature (Table 1). We report a case of a glomus tumor at the mandible. As a new point, the glomus tumor resorbed a bone and teeth roots when the tumor progressed into the mandible.

CASE PRESENTATION

The patient was a 44-year-old Japanese man who complained swelling of the right mandible. Radiographic examination showed a multilocular radiolucency area in the left mandible. Radiographic findings on our case resembled those of a common benign tumor. The lesion occupied to the premolar and molar area and revealed that the tumor resorbed the roots of the teeth. The lesion was removed surgically with the buccal cortical bone and buccal mucosa in contact with the mass of the tumor. The mass fully excised intraorally under general anesthesia, and the inferior alveolar nerve in contact with the mass was preserved. The specimen was pathologically diagnosed as a glomus tumor. Immunohistochemical staining was positive for vimentin, muscle-specific actin/HHF35, and calponin. A hairline-shaped area of positive staining for type IV collagen surrounding the tumor cells was also observed. In contrast, staining for alpha-SMA, cytokeratin (AE1/AE3), cytokeratin (CAM5.2), CK19, CD31, CD34, CD68, p63, S-100, Factor VIII, and desmin was all negative. The Ki-67 labeling index was almost 1%. A recurrent tumor was again detected in the site below the primary tumor at an 8-year follow-up, and it was surgically removed. The patient has had no symptoms of recurrence in 2 years after the second operation.

CONCLUSION

The glomus tumor resorbed a bone and teeth roots when the tumor progressed into the mandible. The immunohistochemical features of the tumor were consistent with those described in previous reports. It is important to completely remove the Glomus tumor.

Glomus tumor: a comprehensive review of the clinical and histopathologic features with report of two intraoral cases

BACKGROUND

Glomus tumors are benign neoplasms that most commonly present in the subungual region. Their occurrence in the oral cavity is exceedingly rare. Here, we present 2 cases from the oral cavity, detail their clinical and histopathologic features, and review the literature for solitary cases involving the oral regions.

STUDY DESIGN

The English language literature was queried for cases of benign glomus tumors in/around the oral cavity. Additional citations were cross-referenced from the identified sources.

RESULTS

Thirty-one cases of solitary glomus tumor in the oral and paraoral regions have been described, including the present cases. Patient age ranged from 10 to 85 years, with an average age of 47 years. In 12 of the 31 cases, the tumors occurred in the lips, 5 in the palate, 4 in the tongue, 4 in the buccal mucosa, 3 in the gingiva, and 1 each in the parotid, pterygoid fossa, and oropharynx. Only 18 of these cases had accompanying immunohistochemical stains, with 14 expressing positivity for muscle cell markers.

CONCLUSIONS

Although glomus tumors have distinct histopathologic features, diagnostic confusion may exist with regard to extradigital locations. Detailed documentation and discussion of the clinical and histopathologic features of rare tumors like these are vital to understanding them.

Rare glomangiosarcoma of the tongue

The glomus tumour is a rare neoplasm derived from the glomus apparatus. Subungual sites are most common with only three published cases involving the dorsal tongue. To our knowledge, this is the first case of an intraoral malignant glomus tumour (glomangiosarcoma) to be published in English literature. We report a case of a single glomus tumour located on the posterior dorsal tongue of a middle-aged man, which was surgically excised. Immunohistological features were indicative of a glomus tumour; however, in this case, malignant features were also discovered, warranting re-excision.

CD34-positive expression in benign nasal glomus tumour: two case reports and a literature review

Nasal glomus tumours are extremely rare neoplasms with poorly understood histogenesis, but which are clinically recognized as benign. The neoplastic cells of glomus tumours resemble normal glomus cells and are arranged around a varying number of thin-walled, sometimes branching, capillaries. CD34 is known to be a marker of tumour progenitor cells. In this report, two cases of benign nasal glomus tumour are presented. The tumours were excised completely via endoscopic endonasal surgery under local anaesthesia. During surgery, there was little bleeding and the post-surgical course for both patients was uneventful. Tumour cells from both cases were positive for α-smooth muscle actin, actin, vimentin and CD34 protein. Thus, CD34 positivity against a background of other immunohisto chemical markers is helpful in the differential diagnosis of glomus tumours.

Glomus tumour of the hard palate: case report and review

Glomus tumours are usually small benign neoplasms that occur in the dermis or subcutaneous tissues of the extremities. They are rare in the oral cavity, only 18 cases having been reported in the medical journals to our knowledge. They arise from the epithelioid glomus cells that normally reside in the stratum retinaculare corii of the skin and are concerned with temperature regulation. We report the clinical, morphological and immunohistochemical features of a case of glomus tumour of the hard palate.

Expression of CD34 in glomus tumors

Immunohistochemical studies were performed in order to characterize glomus tumors. In all cases the glomus tumor cells stained positively for smooth muscle actin. In half of six cases, the glomus tumor cells weakly expressed desmin. They were not reactive with Ulex europaeus agglutinin-I and anti-Factor VIII-related antigen, whereas the only endothelial cells were reactive with them. The tumor cells as well as vascular endothelial cells amongst the tumor cells expressed CD34 in five of the cases.

Arteriovenous hemangioma: a clinicopathological and immunohistochemical study

The clinicopathological and immunohistochemical properties of 6 examples of arteriovenous hemangioma, including 2 intraoral lesions, were reviewed. This distinct benign, acquired vascular lesion, infrequently encountered in the literature, is characterized by multiple thick- and thin-walled vascular spaces resembling arteries and veins, respectively. In our study, we performed elastic stains that revealed a prominent venular component, whereas the arterial aspect was inconspicuous to absent. Our aim was also to elucidate the possible histogenesis of this lesion. Previous reports suggest as pathogenetic mechanisms hamartomatous proliferation either of the subpapillary vascular plexus or of the Suquet-Hoyer canal of the true glomus. Our immunohistochemical studies failed to identify typical glomus cells. In addition, we investigated the mast cell count in all lesions and it was found increased. These findings, as well as recent evidence directly implicating mast cells in angiogenesis, can support the theory of hamartomatous proliferation of the subpapillary plexus. One should also not exclude the possibility of a reactive process resulting in the characteristic features of arteriovenous hemangioma.

Glomus tumor. A histological, histochemical and immunohistochemical study of the various types

Glomus tumors are benign lesions composed of vessels and glomocytes in varying proportions. The histological appearance of the tumors depend upon the ratio of the vascular to the glomus cells and their differentiation as well as upon the amount and composition of the stroma. The aim of the present study was the establishment of criteria for the distinction of glomus tumor-like malformations from neoplasms with glomus cell differentiation. Using a panel of monoclonal and polyclonal antibodies (vimentin, a-smooth muscle actin, desmin, pan-keratin, low molecular weight cytokeratin, EMA, NSE, S-100 protein, Factor VIII, a1-ACT) glomus tumors could be separated into three types: vascular, cellular with myxoid stroma and cellular, solid type. In the first two types the tumor growth is composed of all three components found in normal glomus body, but in a haphazard fashion and thus might be considered as tumor-like malformations. The third type is composed of perivascular arranged cells most of which acquire the phenotypical characteristics of glomocytes. This last tumor probably represent the neoplastic variant of the group of lesions designated by the term glomus tumor.

Glomus tumours: an immunohistochemical profile of 11 cases

We studied 11 glomus tumours immunohistochemically, with a panel of connective tissue and epithelial markers. Most tumours contained small nerve fibres located in connective tissue septae between groups of glomus cells, thus accounting for the frequent occurrence of pain associated with glomus tumours. All tumours stained positively for muscle-specific actin and vimentin. Immunostaining for high and low molecular weight cytokeratins, desmin, myoglobin, S-100 protein, neurofilaments and Factor VIII related antigen was negative. Our findings confirm and amplify the proposed smooth muscle histogenesis of glomus tumours. This immunohistochemical profile may be of diagnostic value in the differential diagnosis of atypical glomus tumours.