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Arkoubi AY. Solitary Glomus Tumor on the Base of the Right Thumb: A Rare Case Report and a Literature Review from Saudi Arabia. Int Med Case Rep J 2024; 17:371-380. [PMID: 38681995 PMCID: PMC11055543 DOI: 10.2147/imcrj.s456808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/09/2024] [Indexed: 05/01/2024] Open
Abstract
A glomus tumor (GT) is a rare and usually benign tumor that originates from the glomus body, which is involved in thermoregulation in the skin. Solitary or multiple, digital or extra-digital, these cutaneous tumors can be benign or malignant. This report describes the diagnosis and surgical management of a solitary glomus tumor at the base of the right thumb in a young Sudanese woman. The diagnosis of glomus tumor was confirmed by medical history, sonographic findings and histopathological report. The lesion was excised via direct complete excision under local anesthesia, resulting in a complete resolution of symptoms. Owing to its high sensitivity level, the use of ultrasound is appropriate to evaluate a lesion suspected to be a glomus tumor. A clinician needs to take into consideration the likelihood of glomus tumors when assessing a patient who has a skin lesion on fingers, toes, or extra-digital area, with pain triggered by temperature changes, pressure, or touch. Additionally, this report includes a review of recent globally reported cases of glomus tumor in the hand to highlight the distinctiveness of this report in context to its atypical location in the area of the thenar eminence and underscoring it as a unique report of its kind from Saudi Arabia.
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Affiliation(s)
- Amr Youssef Arkoubi
- Department of Anesthesia and Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
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Falcone MO, Asmar G, Chassat R. Subungual glomus tumor. HAND SURGERY & REHABILITATION 2024; 43S:101607. [PMID: 37866479 DOI: 10.1016/j.hansur.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
Subungual glomus tumors arise from the glomus body of the digits. They are rare and benign and often in a single location. Their diagnosis relies on the typical clinical triad of symptoms and on imaging findings, mainly magnetic resonance imaging with gadolinium injection. Subungual tumors treatment is complete resection, essential for cure. The different surgical techniques aim to: a painless digit with normal range of motion and sensitivity, without nail deformity after tumour resection, and to recurrence prevention. They vary according to tumor location. Classic surgical approaches are: the nail unit sparing ones (para-ungual, lateral subperiosteal, periungual), and the nail unit non-sparing ones (all transungual approaches with nail bed splitting). In this paper, we review the literature for the different approaches describing the advantages and drawbacks of each of them. We also describe the author's preferred subperiosteal "shark mouth" flap containing the nail plate and the nail bed as a single unit. It can be performed whether the tumor is located centrally, peripherally, or under the germinal matrix with very satisfactory outcomes.
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Affiliation(s)
- Marc-Olivier Falcone
- Clinique Jouvenet, Capio - Ramsay Santé, 6 Square Jouvenet, 75016 Paris, France; Hôpital Privé Paul d'Egine, Capio - Ramsay Santé, 4 Avenue Marx Dormoy, 94500 Champigny sur Marne, France.
| | - Ghada Asmar
- Hôpital Privé Paul d'Egine, Capio - Ramsay Santé, 4 Avenue Marx Dormoy, 94500 Champigny sur Marne, France
| | - Romain Chassat
- Hôpital Privé de l'Ouest Parisien, Capio - Ramsay Santé, 14 Rue Castiglione Del Lago, 78190 Trappes, France
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Hwang JK, Lipner SR. Blue Nail Discoloration: Literature Review and Diagnostic Algorithms. Am J Clin Dermatol 2023; 24:419-441. [PMID: 36971947 DOI: 10.1007/s40257-023-00768-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
Blue nail discoloration is a distinctive clinical presentation, and diagnosis is challenging given the broad differential diagnosis. A comprehensive review of the literature describing blue discoloration of one or multiple nails was performed using the PubMed, Embase, Scopus, and Web of Science databases. A total of 245 publications were included and grouped based on involvement of a single nail (monodactylic) or multiple nails (polydactylic). Monodactylic blue discoloration was associated with tumors or benign nevi, most commonly glomus tumors, followed by blue nevi and less commonly melanomas. Polydactylic blue discoloration was frequently associated with medications (such as minocycline, zidovudine, and hydroxyurea), toxic and exogenous exposures (such as silver), and other medical conditions (such as HIV/AIDS and systemic lupus erythematous). Patients presenting with blue nail discoloration warrant a thorough history, physical examination, and workup to rule out malignancy, systemic disease, or toxic exposure. We present diagnostic algorithms for monodactylic and polydactylic blue nail discoloration to guide workup and treatment plans.
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Risk Factors Associated With Misdiagnosis of Digital Glomus Tumor: A Retrospective Cohort Study. Ann Plast Surg 2022; 89:376-379. [PMID: 35703192 DOI: 10.1097/sap.0000000000003263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Glomus tumors are benign with unique triad of symptoms; however, the delayed diagnosis of these tumors is common. We investigated the possible risk factors for the misdiagnosis of digital glomus tumors, with an aim to treat these patients on time. METHODS We conducted a retrospective cohort study of 104 patients with digital glomus tumors from October 2009 to February 2021. Data pertaining to sex, age, tumor locations, symptoms, imaging modalities, and clinical departments visited by the patients were extracted and analyzed through logistic regression. RESULTS The duration of delayed diagnosis ranged from 3 months to 40 years (mean, 5.5 ± 6.5 years). The total misdiagnosis and recurrence rate are 34.6% and 3.8%, respectively. On the multivariate logistic regression, the misdiagnosis of digital glomus tumor was significantly associated with the clinical departments visited by the patients (P < 0.001). The risk of misdiagnosis of nonhand surgery department visit is 179.741-fold higher than that of hand surgery department visit. CONCLUSIONS The misdiagnosis rate of digital glomus tumor was closely related to the clinical departments visited by the patients. Hand surgeons are the first choice for the treatment of the tumor.
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Guedes GVC, Jácome DT, Alves GF, Monteiro AV. Epidemiological Analysis of Glomus Tumors of the Hand and Association with Recurrence Rate. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2022. [DOI: 10.1055/s-0042-1744466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Introduction Glomus tumors are benign, characterized by microvascular alteration, and mostly found in the subungual region of the hand. They are rare and associated with paroxysmal pain, tenderness on palpation, and thermal sensitivity. The aim of the present research was to analyze the epidemiology of glomus tumors and relate each of the variables with cases of recurrence.
Materials and Methods A retrospective review of medical records was undertaken in our hospital to collect epidemiological numerical variables (time between the onset of symptoms and diagnosis and surgery, age, size of the tumor on magnetic resonance imaging and the histopathological examination, time until recurrence and reoperation after surgery, duration of the follow-up) and categorical variables (gender, ethnicity, laterality, affected finger, location in the hand, surgical technique, smoking, preoperative symptoms, recurrence, and comorbidities). Then, we performed a statistical analysis to identify possible associations of the hand tumors with recurrences.
Results The review identified 66 patients with glomus tumors 52 of which were located in the hand. The mean age of the sample was 49 years, and it was mostly composed of white female patients. Pain was the main related symptom, and most tumors presented sizes between 5 mm and 1 cm. Among the 52 patients, 11 cases presented recurrences, with a mean time until onset of 39.4 months, but 3 of them were initially operated on at other hospitals. None of the variables was shown to be a predictor of recurrence, although we saw that bone involvement on radiographs was only present in certain cases of recurrence.
Conclusion The sample studied was large for this rare disease, and reinforced previous results regarding its epidemiology. As 54% of the cases of recurrence occurred at least twice, we think that genetic, histological and immunohistochemical analyses should be the focus of futures studies, as well as a search for bone and tendon involvement.
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Affiliation(s)
- Giovanni Vilardo Cerqueira Guedes
- Division of Hand Surgery, Department of Orthopedics and Traumatology, Instituto Nacional de Traumatologia e Ortopedia Jammil Haddad (INTO), Rio de Janeiro, RJ, Brazil
| | - Daniel Torres Jácome
- Division of Hand Surgery, Department of Orthopedics and Traumatology, Instituto Nacional de Traumatologia e Ortopedia Jammil Haddad (INTO), Rio de Janeiro, RJ, Brazil
| | - Gabriel Farias Alves
- Department of Orthopedics and Traumatology, Instituto Nacional de Traumatologia e Ortopedia Jammil Haddad (INTO), Rio de Janeiro, RJ, Brazil
| | - Anderson Vieira Monteiro
- Division of Hand Surgery, Department of Orthopedics and Traumatology, Instituto Nacional de Traumatologia e Ortopedia Jammil Haddad (INTO), Rio de Janeiro, RJ, Brazil
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Jabir S, Rodrigo T, Petkar M, Iwuagwu F. Glomus tumours of the upper limb and hand. A clinicopathological review of cases over two decades. J Hand Surg Eur Vol 2022; 47:419-420. [PMID: 34647499 DOI: 10.1177/17531934211049632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Shehab Jabir
- Department of Plastic and Reconstructive Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Thushara Rodrigo
- Department of Histopathology, Broomfield Hospital, Chelmsford, UK
| | - Mahir Petkar
- Department of Histopathology, Hamad Medical Corporation, Doha, Qatar
| | - Fortune Iwuagwu
- St Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
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Hernández V, Lena T, Camacho E, Craviotto M. Digital Glomus Tumor: Bibliographic Review of the Studies Published over the Past 10 Years. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1730392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractGlomus tumors are a mostly benign neoplasm that constitutes less than 4% of upper-limb soft-tissue tumors. Its unspecific clinical presentation, added to its low frequency, leads to a late diagnosis.The objective of the present study is to update the clinical-paraclinical approach and the surgical technique used in the treatment.We carried out a literature review from 2014 to 2019 on digital glomus tumor in the hand in adult patients using the PubMed search engine.In most of the publications analyzed, the diagnosis was clinical, with a delay of 1 to 10 years. Plain radiography is the most requested study; of the 16 articles reporting its indication, only half evidenced compatible changes. Magnetic resonance imaging (MRI) was requested in 15 articles, presenting normal results in 3 of them. The treatment of choice was surgical excision using a transungual approach. Only 4 articles report recurrence after excision.Although there is diversity in the approach to these tumors, we conclude that the diagnosis is clinical, and the treatment surgical, and there is no consensus regarding the paraclinical indication. The information available comes mainly from case reports, publications that contribute to the generation of evidence for the clinical practice in rare diseases such as this one.
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Affiliation(s)
- Victoria Hernández
- Plastic, Reconstructive and Esthetic Surgery Resident, Hospital de Clínicas Dr. Manuel Quintela, Plastic Surgery Department, Montevideo, Uruguay
| | - Tania Lena
- Plastic surgeon, Hospital Central de las Fuerzas Armadas, Montevideo Uruguay
| | - Eliana Camacho
- Plastic, Reconstructive and Esthetic Surgery Resident, Hospital de Clínicas Dr. Manuel Quintela, Plastic Surgery Department, Montevideo, Uruguay
| | - Matías Craviotto
- Plastic surgeon, Hospital Central de las Fuerzas Armadas, Montevideo Uruguay
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Çevik HB, Çiçek ÇA, Kayahan S, Gümüstas SA, Filinte GT. Glomus tumors of the upper extremity. HANDCHIR MIKROCHIR P 2021; 53:72-75. [PMID: 33588493 DOI: 10.1055/a-1333-2459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Glomus tumors are uncommon and painful benign perivascular neoplasms. They usually occur in the subungual region of phalanx, and present with a classic clinical triad of localized tenderness, cold hypersensitivity, and excruciating paroxysmal pain. The aim of this study was to review 45 cases of glomus tumor according to the clinical, radiological and therapeutic characteristics, and the clinical and functional outcomes of surgical treatment. MATERIALS AND METHODS A retrospective review was made of 45 glomus tumors of the upper extremity operated on between June 2005 and January 2019. Data were collected of demographic characteristics and the diagnostic, immunohistochemical, therapeutic and postoperative clinical findings. RESULTS The patients comprised 69 % females and 31 % males with a median age of 41 years at the time of surgery. The most commonly affected anatomic location was the digits (87 %). Of the 39 cases with an affected digit, there was a predominance of the middle finger in 28 % and the peri-subungual area in 51 %. There was no recurrence or need for secondary surgical intervention in any patient in this study. The mean QuickDASH score was 1.47 at mean 66 months follow-up. CONCLUSIONS Glomus tumor, which is usually seen in the middle finger of middle-aged women, presents with excruciating paroxysmal pain out of proportion to the tumor size. The long-term outcomes after surgical loupe-assisted surgery with a transungual approach were seen to be good, without local recurrence and an acceptable rate of postoperative nail dystrophy.
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Affiliation(s)
- Hüseyin Bilgehan Çevik
- Ankara Diskapi Yildirim Beyazit, Training and Research Hospital, Orthopaedics and Traumatology
| | - Çagla Amutkan Çiçek
- Istanbul Dr Lufti Kirdar Kartal Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery
| | - Sibel Kayahan
- Istanbul Dr Lufti Kirdar Kartal Training and Research Hospital, Pathology
| | - Seyit Ali Gümüstas
- Istanbul Dr Lufti Kirdar Kartal Training and Research Hospital, Orthopaedics and Traumatology
| | - Gaye Taylan Filinte
- Istanbul Dr Lufti Kirdar Kartal Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery
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Asmar G, Mati T, Pop IA, Falcone MO. The 'shark mouth' flap approach for digital glomus tumours in 24 patients: technique and clinical outcomes. J Hand Surg Eur Vol 2020; 45:153-159. [PMID: 31414608 DOI: 10.1177/1753193419867049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This retrospective, single-centre study was carried out on patients with digital subungual glomus tumours. We describe a subperiosteal approach with a 'shark mouth' flap containing the nail plate and nail bed as a single unit, providing ideal exposure and easy access to the tumour. It combines the advantages of the transungual and lateral approaches, whether the subungual tumours are located centrally, peripherally or under the germinal matrix. The 'shark mouth' flap approach was used by the same surgeon in 24 patients with solitary glomus tumours of the fingers. Clinical outcomes at the early postoperative phase and at the last follow-up were satisfactory. Pain relief and wound healing were quickly achieved. No complications, such as fingertip numbness or nail deformities, were observed, and there was only one recurrence. This approach is reliable, nail-sparing and less time-consuming than other techniques. Level of evidence: IV.
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Affiliation(s)
- Ghada Asmar
- Ramsay Générale de Santé - Capio, Hôpital Privé Paul d'Egine, Champigny-sur-Marne, France
| | - Tahar Mati
- Ramsay Générale de Santé - Capio, Hôpital Privé Paul d'Egine, Champigny-sur-Marne, France
| | - Ioana Anastasia Pop
- Ramsay Générale de Santé - Capio, Hôpital Privé Paul d'Egine, Champigny-sur-Marne, France
| | - Marc-Olivier Falcone
- Ramsay Générale de Santé - Capio, Hôpital Privé Paul d'Egine, Champigny-sur-Marne, France.,Clinique Internationale du Parc Monceau, Paris, France
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Reinders EF, Klaassen KM, Pasch MC. Transungual Excision of Glomus Tumors: A Treatment and Quality of Life Study. Dermatol Surg 2020; 46:103-112. [DOI: 10.1097/dss.0000000000002006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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