Updated: 6/22/2021

Glomus Tumor

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https://upload.orthobullets.com/topic/8075/images/glomus tumor clinical photo.jpg
https://upload.orthobullets.com/topic/8075/images/glomus erosion into distal phalanx.jpg
https://upload.orthobullets.com/topic/8075/images/glomus mri.jpg
https://upload.orthobullets.com/topic/8075/images/glomus_tumor histology.jpg
https://upload.orthobullets.com/topic/8075/images/glomus tumor high power.jpg
  • summary
    • Glomus Tumors are rare benign tumors of the glomus body, often occurring in the subungual region.
    • The condition is typically seen in patients between the ages of 20 and 40 who present with a painful subungal mass with bluish discoloration. 
    • Diagnosis is made with a biopsy showing a well-defined lesion lacking cellular atypia or mitotic activity with the presence of small round cells with dark nuclei.
    • Treatment is usually marginal excision.
  • Epidemiology
    • Demographics
      • occurs in patients 20 to 40 years of age
    • Anatomic ocation
      • 75% occur in hand
      • 50% are subungual
      • 50% have erosions of distal phalanx (primary involvement of bone being very rare)
      • less common locations: palm, wrist, forearm, foot
  • Etiology
    • Forms
      • may involve either the soft tissue and/or bone
    • Frequently associated with a delay in diagnosis
  • Anatomy
    • Glomus body
      • the glomus body is a perivascular temperature regulating structure frequently located at the tip of a digit or beneath the nail
  • Presentation
    • Symptoms (classic triad)
      • paroxysmal pain
      • exquisite tenderness to touch
      • cold intolerance
    • Physical exam
      • small bluish nodule
      • often difficult to see, especially in the subungual location
      • nail ridging or discoloration is common
      • Love test
        • pressure to the area with a pinhead elicits exquisite pain
        • 100% sensitive, 78% accurate
      • Hildreth test
        • tourniquet inflation reduces pain/tenderness and abolishes tenderness to the Love test
        • 92% sensitive, 91% specific
  • Imaging
    • Radiographs
      • glomus tumors can produce a pressure erosion of the underlying bone and an associated deformity of the bone cortex
    • MRI
      • helpful to establish diagnosis
      • present as a low T1 signal and high T2 signal
  • Studies
    • Histology
      • well-defined lesion lacking cellular atypia or mitotic activity
        • small round cells with dark nuclei
        • associated small vessels in a hyaline/myxoid stroma
      • can show gland-like or nest structures, separated by stromal elements
  • Treatment
    • Operative
      • marginal excision is curative
        • indications
          • symptoms affecting quality of life
        • outcomes
          • due to the benign nature of this disease, recurrence is uncommon
          • several cases of malignant glomus tumors have been reported in the literature
      • reconstruction of nail bed contour with autologous fat graft
        • indications
          • for large defects after resection
  • Complications
    • Recurrence
      • 20%

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(OBQ13.1) A 43-year-old women presents with a long-standing history of pain at the tip of her right non-dominant middle finger. Pain is exacerbated by cold weather. She denies systemic symptoms or preceding trauma. She has seen a number of physicians but no formal diagnosis as been made. Physical examination reveals no distinct mass or color change. Pain is reproduced by palpating over the ulnar nail bed of her distal middle finger. Radiographs and routine laboratory results are within normal limits. MRI images are shown in Figures A-C. What is the most likely diagnosis?

QID: 4636
FIGURES:
1

Raynaud's phenomenon

2%

(66/3208)

2

Epidermal inclusion cyst

11%

(347/3208)

3

Osteomyelitis

0%

(10/3208)

4

Glomus tumor

84%

(2706/3208)

5

Osteoid osteoma

2%

(50/3208)

L 2 B

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(OBQ11.113) A 20-year-old male presents with 3 months of pain and swelling in his ring finger. Clinical photo, radiograph, and histology slide are shown in Figures A through C. What is the most likely diagnosis?

QID: 3536
FIGURES:
1

Melanoma

6%

(171/2765)

2

Squamous cell carcinoma

3%

(83/2765)

3

Synovial sarcoma

5%

(127/2765)

4

Epithelioid sarcoma

15%

(420/2765)

5

Glomus tumor

70%

(1948/2765)

L 2 C

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