Multiple glomus tumor: a case report and review of the literature

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.

Low-Grade Malignancy Glomus Tumor in a Setting of Multiple Glomus Tumors - Case Report

BACKGROUND:

Glomus tumors are rare neoplasms accounting for less than 2% of all soft tissue tumors but multiple lesions may be seen in up to 10% of the patients. Solitary glomus tumor (GT) most frequently appears as small nodule in specific locations such as subungual region or deep dermis. However, rarely these entities have been observed in extracutaneous locations such as the gastrointestinal, cardiovascular, respiratory tracts, and other visceral organs. A small fraction of the GTs may present as tumors of uncertain malignant potential or as malignant glomus tumors.

CASE PRESENTATION:

We report a patient with multiple glomus tumors on the time of diagnosis, which was histologically diagnosed as an atypical glomus tumor following resection of a tumor thrombus in the left renal vein, inferior vena cava trombus with intracardial extension, and mitral valve specimen. The intramuscular lesion from the thigh was diagnosed as a glomus tumor of uncertain malignant potential. Further examinations revealed multiple lesions trough her body: kidneys, breast, heart and subcutaneous tissue. The diagnosis of glomus tumor of uncertain malignant potential versus glomus tumor with low malignant potential could be quite challenging, and the clinical course may be as a determining factor for final diagnosis.

CONCLUSION:

To our knowledge, this is the only known case of glomus tumor with multiple organ involvement and aggressive biological behavior at presentation.

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.

Glomus tumor closely related to a branch of the left sural nerve: a case of a rare lesion occurring at unusual location

Glomus tumors are rare benign neoplasms arising from the glomus bodies of the skin; they account for 1.6 % of all soft tissue tumors. Since the great majority of these lesions are found on fingers and toes (especially under the nail, on the fingertip, or in the foot), a correct clinical diagnosis may prove difficult if one or more glomus tumors occur on an extra digital location. We report a case of a glomus tumor with prominent vascular component found in the left leg closely related to a branch of the sural nerve and originally believed to be a schwannoma.

Characteristics of glomus tumors in the hand not diagnosed on magnetic resonance imaging

PURPOSE

To determine whether the diagnosis of hand glomus tumors by magnetic resonance imaging (MRI) is associated with tumor size, tumor pathology, tumor location, and/or clinical suspicion.

METHODS

We reviewed our pathology database for patients with hand glomus tumors diagnosed between 2006 and 2013 and included those patients who had preoperative MRI at our institution. We excluded patients with recurrent and persistent tumors. Magnetic resonance imaging reports were reviewed for clinical history, tumor location, and associated bone erosion. Pathology reports were reviewed for diagnosis and tumor size. We classified MRI studies as positive (glomus tumor diagnosis), negative (no mention of glomus tumor as possible diagnosis), or indeterminate (glomus tumor mentioned as possible differential diagnosis). Fisher exact test was used to compare positive studies and those that were nondiagnostic (ie, either negative or indeterminate).

RESULTS

Of the 46 patients who had pathologically confirmed hand glomus tumors, 38 had preoperative MRI studies. A total of 24 MRI studies were positive, 5 were indeterminate, and 7 were negative. Five patients had atypical pathology, 1 had a multifocal tumor, and 2 had extra-digital hand glomus tumors. Failure to diagnose glomus tumors on MRI was associated with atypical pathology, atypical location (ie, not located in the subungual region), absence of bone erosion, and lack of clinical suspicion. Tumor size was not associated with MRI diagnosis.

CONCLUSIONS

In this series of 36 hand glomus tumors, one-third of MRI studies were nondiagnostic. Occurrence of nondiagnostic MRIs was more likely when glomus tumors were pathologically and/or anatomically atypical, without bone erosion, and with no or unrelated clinical history provided. These findings highlight the continued importance of clinical suspicion in glomus tumor diagnosis.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic IV.

Three cases of subungual glomus tumours of the fingers - a case series

Subungual glomus tumours are rare tumours (2% of all hand tumours) presenting with excruciating pin point pain under the nail which is often misdiagnosed. Diagnosis is often always clinical. Here, we report the case of three patients who had subungual glomus tumour not diagnosed earlier for many years.

Subungual glomus cell proliferation in the toe: a case report

Glomus tumors are rare benign neoplasms. They typically present with a triad of severe pain, point tenderness, and cold sensitivity. Most glomus tumors will form well-circumscribed nodules, and excisional biopsy of masses detected by ultrasonography or magnetic resonance imaging of the lesion can relieve the symptoms. We describe a 30-year-old female patient with nontumorous glomus cell proliferation with clinical symptoms similar to those of glomus tumors. The lesion was treated by exploration and excision, with a satisfactory clinical outcome.

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.

Surgical extirpation of glomus tumor from rare localization on the upper extremity

Objective. To report on a very rare case of a glomus tumor manifested on the upper arm in a healthy young male patient. Case Presentation and Intervention. A 22-year-old male patient presented with bluish multifocal venous malformation on the left upper arm and was admitted for venous malformation excision. Pain, discomfort, and upper arm paraesthesia had been present for almost 6 years. Ultrasonography revealed septet tumor without blood flow in the subcutaneous region of anterior aspect of the upper arm. A multifocal venous malformation approximately 5–10 mm in diameter was excised. Histological examination showed dilated vascular area with proliferated glomus cells with round nucleus in the wall of dilated vascular structures. Based on histological examination, the final diagnosis was made as “glomangioma.” Conclusion. Histological examination is the only method that can establish final diagnosis. Currently, the only available treatment for this type of tumor is surgical excision.

Glomus tumor of the shoulder: A case report and review of the literature

Glomus tumors are benign neoplasms that arise from neuromyoarterial glomus bodies, with clinical manifestations that include acute pain, cold intolerance and tenderness. Glomus tumors may occur anywhere in the skin, soft tissue or gastrointestinal tract, but are most frequently encountered in the nail bed of the hands. The present study reports the case of a 30-year-old female with a history of shoulder pain caused by a cystic neoformation. Following surgery, a microscopic examination revealed nests of small cells of a rounded and regular shape. The tumor cells exhibited positive expression for CD34 and smooth muscle actin. This study supports and confirms the fact that a glomus tumor is a benign neoplasm that may occur in multiple locations. Therefore, the significance of a histological and immunohistochemical approach for a correct characterization of this lesion is required.

The use of stereotactic body radiation therapy for local control of glomangiomatosis: a case report

The vast majority of glomangiomas are small, benign neoplasms that can occur anywhere in the body but typically arise in the subcutaneous tissues of the extremities and are capable of causing extreme pain. Typically, these lesions are managed surgically with excellent rates of tumor control. On occasion, patients present with a variant of the glomangioma tumor consisting of numerous or recurrent nodules, a condition classified as glomangiomatosis. The authors present a case report of a young patient with multiply recurrent painful glomangiomas of the left foot, who was ultimately diagnosed with glomangiomatosis pedis. After multiple surgeries and surgical consultations, no surgery other than amputation was recommended. Therefore, the patient sought consultation with regard to stereotactic body radiation therapy (SBRT). In the absence of other options, and based on its effectiveness in treating glomus tumors of the head and neck which display similar natural history and histologic features, SBRT was offered. The patient underwent SBRT to the largest of his remaining tumors with excellent local control and significant reduction in pain at two and a half years follow-up.

A glomus tumour arising from the flexor aspect of the forearm: a case report with review of the literature

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.

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.

Short-scar surgical approach for the treatment of glomus tumor of the digit

BACKGROUND

A glomus tumor is a biologically benign neoplasm. The traditional surgical approach to treat this tumor boasts the lowest recurrence rates but may cause nail deformities.

OBJECTIVE

A short-scar surgical approach was applied, with the aim of preserving the aesthetics of the nail.

METHODS

Between January 1999 and January 2009, 25 patients who underwent surgery for a glomus tumor were included in the study. All patients underwent radical resection with three different surgical approaches based on the location of the tumor.

RESULTS

All patients who were operated on had complete regression of pain immediately after surgery and at postsurgery follow-ups.

CONCLUSION

The treatment of glomus tumors consists of surgical excision, which is successful if properly executed. Excision of sensitive afferent nervous fibers is a prerequisite to achieve regression of pain. A short-scar surgical approach ensures complete eradication of the tumor and preservation of nail aesthetics.

Diagnosis and management of glomus tumors of the hand

AIM AND BACKGROUND

Glomus tumors are hamartomas that account for 1% to 5% of all soft tissue tumors of the hand. These tumors are usually benign. However, malignant degeneration can sometimes occur. They are usually characterized clinically by paroxysmal pain. Herein, we present our experience with 8 patients diagnosed with glomus tumors treated within the past 10 years.

MATERIALS AND METHODS

Eight patients who were diagnosed with glomus tumor of the hand were treated. Excruciating pain upon palpating the tumor was present in all the patients. Imaging studies such as magnetic resonance imaging were obtained but were only marginally helpful in locating and defining the surface topography for tumor resection. Meticulous dissection in a bloodless field and use of an operating microscope from the start of the operation were used for complete removal.

RESULTS

Complete excision of the tumor with free margins was confirmed in all 8 cases. However, 1 of the patients had recurrence of the tumor, which presented 4 weeks postoperatively. No other recurrence was observed during the follow-up period (1 to 10 y). The postoperative course in all patients was uneventful except for deformed fingernail formation in 3 of the patients.

CONCLUSIONS

Glomus tumor is a rare disease; we encountered only 0.26% cases in our patients (3014 patients referring for hand surgery) during a 10-year period. Imaging studies are not very helpful. Preoperative marking of the maximum point of pain helps the surgeon somewhat to locate the tumor clinically. We believe that a bloodless operation field and magnification are essential prerequisites for successful surgery. We also note that pain alleviation and no pain recurrence 2 months after surgery clinically signify a cure. The possible development of permanent nail deformity should be anticipated and must be discussed with the patient preoperatively.

The anatomic location of digital glomus tumor recurrences

PURPOSE

We examined the anatomic location of recurrences of digital glomus tumors treated with surgical excision to make inferences on the causes of recurrence.

METHODS

We retrospectively reviewed 12 cases of glomus tumors of the hand treated surgically over an 8-year period. Two of these patients presented with recurrences after previous glomus tumor excision surgery elsewhere. The location of recurrences, duration of symptoms, gender, revision surgeries, and histological specimens were analyzed.

RESULTS

All tumors developed in the periungual and subungual area of the digits. Five of the 12 patients had recurrences, with one of these patients having a second recurrence after revision surgery. All recurrent tumors occurred in new, separate locations from the original lesions. The recurrences presented from 2 months to 5 years after the initial surgery. All surgical specimens from the index surgeries, as well as revision procedures, were examined by a pathologist and confirmed to be glomus tumors. There were no discernible differences in the histology features of the tumors that recurred compared to those that did not.

CONCLUSIONS

Traditionally, recurrences of digital glomus tumors after surgical excision are thought to be rare. Inadequate resection was considered the likely cause in most cases. However, recurrent symptoms might be attributed to small, synchronous, satellite lesions not detected during the original surgery. A careful preoperative and intraoperative examination for synchronous lesions should be made, and patients should be informed of the risk of recurrent symptoms.

Lower extremity glomus tumors: comprehensive review for surgeons

The diagnosis of a lower extremity glomus tumor (GT) is often delayed owing to the lack of awareness and low level of suspicion by the treating physician. GT is thought to arise from cutaneous arteriovenous connections, often involving the nail beds. The unusual location of the lower extremity often leads to missed or delayed diagnosis and management. Surgical excision of GT is often curative and provides significant symptomatic relief. There is a paucity of information in regard to GT in general, especially among vascular surgeons. The aim of this report is to make the surgical community more aware of this disease entity based on the analysis of our own experience and review of the literature.

Multiple glomus tumors in gastrocnemius muscle: a case report

Glomus tumors are rare benign tumors that account 1-5% of soft tissue tumors of the hand. Most of the lesions occurred in the subungal region of the distal phalanx. We describe an unusual case of recurrent glomus tumor located in lower leg. The final diagnosis was established by pathologic examination of the surgical resection specimen.

Glomus tumors

Glomus tumors are rare vascular tumors that are found most commonly in the hand. Although the tumors are benign, they can cause intense focal pain. Patients often go undiagnosed or misdiagnosed for many years because the tumors are small, usually not palpable, and have varying presentations. A combination of magnetic resonance imaging and clinical examination is used to support the diagnosis. Surgical excision normally provides complete pain relief. An awareness of the diagnosis is critical to preventing an unnecessary delay in treatment.

Tumeur glomique de l'avant-bras : à propos d'un cas

The authors report a case of a glomus tumor of the soft-tissues of the forearm in a 23 year old woman. The diagnosis was suspected on MRI, and confirmed by a biopsy. The result after surgical resection was excellent, just like other cases in the literature.

Glomangiomatosis: magnetic resonance imaging findings in three cases

The term glomangiomatosis refers to multiple glomus tumors, a rare condition. Unlike solitary glomus tumors, multiple glomus tumors are not always located in the subungual region, making diagnosis difficult. We report on three cases of glomangiomatosis in the foot, and describe their MR findings and review previous case reports on this subject.

Multiple occurrences of different histologic types of the glomus tumor

A patient with 3 glomus tumors that occurred at different locations and times is presented. Two of the 3 tumors were of the same histologic type. The third tumor was a different type. Although it is rare, a solitary type of glomus tumor on initial presentation may exhibit multiple occurrences in the same patient.