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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
Introduction
  • Rare benign tumor of the glomus body, often occurring in the subungual region
    • may involve either the soft tissue and/or bone 
    • frequently associated with a delay in diagnosis 
    • glomus tumor may also be called a paraganglioma
  • Epidemiology
    • demographics
      • occurs in patients 20 to 40 years of age
    • location
      • 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
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 post
      • 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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(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? Review Topic

QID: 3536
FIGURES:
1

Melanoma

6%

(145/2317)

2

Squamous cell carcinoma

3%

(71/2317)

3

Synovial sarcoma

5%

(108/2317)

4

Epithelioid sarcoma

15%

(349/2317)

5

Glomus tumor

70%

(1630/2317)

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