Giant thigh glomus tumor of uncertain malignant potential: Case report with pathologic-radiologic correlation.

INTRODUCTION: Glomus tumors (GT) are rare, benign tumors that arise from glomus bodies and usually develop in digital areas. Extradigital GT are exceptional and thigh location is infrequent. CASE REPORT: We report a case of a GT of the thigh in a 79-year-old male patient that measured 9.5 cm in maximum size. The GT lay above the muscular fascia without infiltrating it. Internal hypervascularity was seen by spectral Doppler ultrasound. Magnetic resonance image showed a heterogeneous mass with hyperintense and hypointense components and internal lobes with liquid-liquid levels. Histopathology revealed a monotonous round-cell proliferation with central nuclei without atypia or mitotic figures, around small-caliber vessels. These cells expressed smooth muscle actin and pericellular collagen IV. GT of uncertain malignant potential was diagnosed. The mass was completely removed. The patient did not experience local relapse nor distant metastasis. CONCLUSION: GT are rare soft tissue tumors whose diagnosis of unusual giant masses in uncommon locations may be delayed and misdiagnosed given the low suspicion.

An Extradigital Glomus Tumor of the Median Antebrachial Vein.

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.

The usefulness of ultrasound imaging in digital and extradigital glomus tumors.

Recent years have witnessed an increase in the use of ultrasound imaging of the skin in the field of dermatology, as the technique reveals details of vessels and other structures that cannot be detected on physical examination. Extradigital glomus tumors are rarely seen in clinical practice and can pose a diagnostic challenge for dermatologists. We report on 4 patients with a clinical suspicion of extradigital glomus tumor and on 1 patient with a clinical suspicion of subungual glomus tumor. All 5 patients underwent ultrasound examination in B mode and color and pulsed-wave Doppler prior to surgical excision of the tumor and histologic examination, which confirmed the diagnosis in each case. Ultrasound imaging of the skin, combined with clinical findings, provided a simple, noninvasive way of making a prompt diagnosis and identifying the exact location of the lesion for surgical removal.

Point Tenderness for 35 Years: A Rare Presentation of a Glomus Tumor in the Proximal Upper Extremity.

Glomus tumors are rare benign neoplasms that are commonly found on the fingers and distal extremities. Clinically, they are often associated with a symptom triad of moderate pain, cold sensitivity, and point tenderness. These tumors are often not considered during a clinical workup due to their rarity and can be misdiagnosed due to their diverse clinical presentations. Glomus tumors are made up of mesenchymal cells derived from glomus bodies, which are specialized arteriovenous (AV) anastomoses primarily responsible for thermoregulation. Microscopically, they present as intricate nests of endothelial cells surrounding glomus bodies, which can clinically manifest as point tenderness. Glomus tumors are usually benign and are commonly found in locations with a high concentration of glomus bodies such as the fingers. Extradigital tumors are very rare and usually not considered in primary diagnosis. This can lead to patients experiencing years and, in this case, decades of unexplained pain. The diagnostic workup for glomus tumors should include an initial Doppler ultrasound and a definitive diagnosis via immunohistochemistry (IHC). They can be completely cured with surgical excision. Although most glomus tumors are benign and easily treatable, they are often not considered in differential diagnoses when assessing for point tenderness.  This case illustrates an atypical presentation of a glomus tumor that caused 35 years of chronic pain and was incidentally misdiagnosed on imaging, leading to treatment delay by an additional eight months. This exemplifies the necessity of including glomus tumors within the differential diagnosis and diagnostic workup for point tenderness and soft tissue masses of the upper extremity.

Glomus tumor of the scapular neck with axillary nerve compression at the shoulder. A case report.

Background: Glomus tumors, also known as benign acral tumors are extremely rare. Previous glomus tumors from other regions of the body have been linked to neurological compression symptoms, however axillary compression at the scapular neck has never been described. Case presentation: Here, we report a case of axillary nerve compression in a 47-year-old man, secondary to a glomus tumor of the neck of the right scapula, initially misdiagnosed with biceps tenodesis performed and no pain improvement. The magnetic resonance imaging demonstrated a well-contoured, 12 mm tumefaction at the inferior pole of the scapular neck T2-hyperintense and T1-isointense and interpreted as a neuroma. An axillary approach allowed the dissection of the axillary nerve, and the tumor was completely removed. The pathological anatomical analysis resulted in a nodular red lesion measuring 14 × 10 mm, delimited and encapsulated with a definitive diagnostic of glomus tumor. The neurologic symptoms and pain disappeared 3 weeks after surgery and the patient reported satisfaction with the surgical procedure. After 3 months, the results remain stable with a complete resolution of the symptoms. Conclusions: In cases of unexplained and atypical pain in the axillary area, and to avoid potential misdiagnoses and inappropriate treatments, an in-depth exploration for a compressive tumor should be performed as a differential diagnosis.

Extradigital Glomus Tumor Mimics an Intrinsic Nerve Tumor in a Trauma Patient: Case Report and Literature Review.

Glomus tumors are rare, painful, and usually benign neoplasms that typically occur at the subungual aspect of digits. Rarely, glomus tumors may arise in other areas of the body. We present a case of an extradigital glomus tumor on a forearm with prior trauma that presented with symptoms of an isolated peripheral neuropathy. Our review of literature reveals how upper or lower extremity glomus tumors can mimic neuropathies secondary to intrinsic nerve tumors (schwannoma, neurofibroma, or neuroma), radiculopathies, or manifestations of a complex regional pain syndrome (CRPS). We emphasize the need to consider a broad differential diagnosis that includes glomus tumor when evaluating patients with painful dermal masses producing peripheral neuropathy or radiculopathy signs owing to the infiltrative growth pattern into or mass effect exerted on nearby nerves.

Extradigital Glomus Tumor Revisited: Painful Subcutaneous Nodules Located in Various Parts of the Body.

BACKGROUND: Glomus tumor is a common lesion of the subungual area of the hand fingers. However, glomus tumors located outside the hand region are rare and the diagnosis is often difficult due to their low incidence and lack of distinct clinical features in the physical examination. The presented article contains five cases of extradigital glomus tumors with a short review of the literature. PATIENTS AND METHODS: Five cases of extradigital glomus tumor were included in the study. All lesions were purple colored subcutaneous nodules with sharp pain by digital palpation. All lesions were examined with ultrasound imaging were operated under local anesthesia using loupe magnification. RESULTS: Among five patients, only one patient was female with a mean age of 35. Two lesions were located at the arm region, two at the crural region and one at the sternal area. The smallest nodule was 0.5 cm and the biggest lesion was 2 cm in diameter. In all the cases, the early postoperative period was uneventful without any surgical complication or acute recurrence. The postoperative 1(st) year examination of all patients revealed complete resolution of the pain and no recurrence was encountered. CONCLUSIONS: Glomus tumor should be kept in mind in the differential diagnosis of all painful subcutaneous lesions especially for those with purple reflection on the skin surface. In this manner, patients with extradigital glomus tumors may be diagnosed earlier and unnecessary and wrong treatments may be prevented.