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Updated: Jun 22 2021

Glomus Tumor

Images tumor clinical photo.jpg erosion into distal phalanx.jpg mri.jpg histology.jpg 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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