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%
QUESTIONS 1 of 3 1 2 3 Previous Next (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: A B C Type & Select Correct Answer 1 Raynaud's phenomenon 2% (72/3295) 2 Epidermal inclusion cyst 11% (358/3295) 3 Osteomyelitis 0% (10/3295) 4 Glomus tumor 84% (2774/3295) 5 Osteoid osteoma 2% (51/3295) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (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: A B C Type & Select Correct Answer 1 Melanoma 6% (172/2819) 2 Squamous cell carcinoma 3% (88/2819) 3 Synovial sarcoma 5% (129/2819) 4 Epithelioid sarcoma 15% (426/2819) 5 Glomus tumor 70% (1986/2819) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (2) Podcasts (1) Login to View Community Videos Login to View Community Videos Glomus Tumor Histopathology Derek W. Moore Pathology - Glomus Tumor B 4/6/2012 788 views 4.7 (7) Login to View Community Videos Login to View Community Videos Surgical Resection of a Glomus Tumor Pathology - Glomus Tumor D 4/6/2012 511 views 2.0 (5) Pathology⎪Glomus Tumor Orthobullets Team Pathology - Glomus Tumor Listen Now 7:17 min 6/16/2020 126 plays 5.0 (1)