The history, clinical photograph, radiograph, and histology section are all consistent with a diagnosis of glomus tumor, a benign tumor often found in the hand and under the fingernails. Developing from the glomus body, they were previously called paragangliomas and characteristically, they are often quite painful. Placing the finger in cold water can exacerbate the pain. Even though they are benign tumors, they are locally aggressive, and this coupled with the significant pain leads many to suggest amputation, particularly for tumors as aggressive as this case (Illustration A).
The clinical photograph here shows an ecchymotic fingertip without identification of a specific mass. Given the intraosseous location of this patient's tumor, the bone has become very cystic and shows significant erosive changes. The histological slide shows the bland appearing stroma with the neoplastic tumor cells showing their classic dark nuclei and pink cytoplasm.
McDermott and Weiss review the history, diagnosis, and treatment of glomus tumors. As these tumors can often be small and difficult to visualize, patients often go undiagnosed or misdiagnosed for years. Advanced imaging like MRI can help support the diagnosis. While surgical excision typically provides complete pain relief, locally aggressive glomus tumors sometimes require aggressive surgical resection.
1, 2, 3, 4) While melanoma, squamous cell carcinoma, synovial sarcoma, and epithelioid sarcoma are all very common in the hands, none have the same histopathological appearance as the glomus tumor seen here.
Campanacci M. Glomus tumor. In: Campanacci M, Enneking WF, eds. Bone and Soft Tissue Tumors: Clinical Features, Imaging, Pathology and Treatment. 2nd ed. New York, NY: Springer-Verlag; 1999:1083-1087.
McDermott EM, Weiss AP. Glomus tumors. J Hand Surg Am. 2006 Oct;31(8):1397-400. Review.
PMID:17027805 (Link to Abstract)