Glomus Tumor - A Delayed Diagnosis, Yet Simple Cure: Case Reports
Keywords:
Glomus Tumor, Sub-ungual, Love test, Transungual, Benign tumor, Hallux tumor, Glomus body
Abstract
Glomus tumors are rare soft-tissue neoplasms that constitute 2% of all soft-tissue tumors in the extremities. They are painful
lesions that can impair quality of life. Diagnosis is often delayed as they can easily be confused with more common pathologies. They are best diagnosed through MRI scan or ultrasonography of the concerned digit. We present two cases in this article, one of a subungual glomus tumor of the great toe (Hallux) and one of the index finger. Both tumors had a delay in
diagnosis as this tumor cannot easily be diagnosed through simple radiographs. They showed classical clinical symptoms. Both were eventually diagnosed on MRI scan. Surgical excision is the gold standard in treatment of subungual glomus tumors
and is also curative. We used a transungual approach for the hallux and a lateral subperiosteal approach for the index finger. In conclusion, glomus tumors are rare, benign tumors that commonly occur in the sub-ungual region. High clinical suspicion is important for clinical diagnosis. MRI scan and ultrasound can diagnose the tumor and yield information about local spread. Surgical excision is usually curative with approximately 10% chance of recurrence and rare chance of malignant transformation.
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24. Chen SH, Chen YL, Cheng MH, Yeow KM, Chen HC, Wei FC. The use of ultrasonography in preoperative localization
of digital glomus tumors. Plast Reconstr Surg. 2003 Jul;112(1):115-9.
25. Fornage BD. Glomus tumors in the fingers: diagnosis with US. Radiology. 1988 Apr;167(1):183-5.
26. Cha SM, Shin HD, Park YC. Surgical Resection of Occult Subungual Glomus Tumors: Cold Sensitivity and Sonographic Findings. Ann Plast Surg. 2018 Oct;81(4):411- 415.
27. Al-Qattan MM, Al-Namla A, Al-Thunayan A, Al-Subhi F, El-Shayeb AF. Magnetic resonance imaging in the diagnosis
of glomus tumours of the hand. J Hand Surg Br. 2005 Oct; 30(5):535-40.
28. Mundada P, Becker M, Lenoir V, Stefanelli S, Rougemont AL, Beaulieu JY, et al. High resolution MRI of nail tumors
and tumor-like conditions. Eur J Radiol. 2019 Mar;112:93-105.
29. Lee SH, Roh MR, Chung KY. Subungual glomus tumors: surgical approach and outcome based on tumor location.
Dermatol Surg. 2013 Jul;39(7):1017-22.
30. Tada H, Hirayma T, Takemitsu Y. Prevention of postoperative nail deformity after subungual glomus resection. J Hand Surg Am. 1994;19:500–3.
31. Grover C, Khurana A, Jain R, Rathi V. Transungual surgical excision of subungual glomus tumour. J Cutan Aesthet Surg.
2013;6(4):196-203. doi:10.4103/0974-2077.123401
32. Li TS, Choong MY, Wu CI, Chen HC, Chung KC. Autologous fat graft to restore nail bed contour following resection of a subungual glomus. J Hand Surg Am. 2011;36:726–8.
33. Kim YJ, Kim DH, Park JS, Baek JH, Kim KJ, Lee JH. Factors affecting surgical outcomes of digital glomus tumour: a multicentre
study. J Hand Surg Eur Vol. 2018 Jul;43(6):652-658.
34. Gandhi J, Yang SS, Hurd J. The anatomic location of digital glomus tumor recurrences. J Hand Surg Am. 2010;35:986–9.
an institutional experience of 138 cases. Int J Surg Pathol. 2015 May;23(3):181-8.
2. Fletcher CDM, Unni K, and Meretens F, editors. Pathology and Genetics of Tumours of the Nervous System. Lyon,
France: IARC Press; 2002.p.136–137, The World Health Organization of Tumours; vol 5.
3. Drape JL, Idy-Peretti I, Goettmann S, Guerin-Surville H, Bittoun J. Standard and high resolution magnetic resonance imaging of glomus tumors of toes and fingertips. J Am Acad Dermatol. 1996 Oct;35(4):550-5.
4. Chiang YP, Hsu CY, Lien WC, Chang YJ. Ultrasonographic appearance of subungual glomus tumors. J Clin Ultrasound.
2014 Jul-Aug;42(6):336-40.
5. Theumann NH, Goettmann S, Le Viet D, Resnick D, Chung CB, Bittoun J, et al. Recurrent glomus tumors of fingertips: MR imaging evaluation. Radiology. 2002 Apr;223(1):143-51.
6. Matloub HS, Muoneke VN, Prevel CD, Sanger JR, Yousif NJ. Glomus tumor imaging: use of MRI for localization of occult lesions. J Hand Surg Am. 1992 May;17(3):472-5.
7. Weiss SW, Goldblum JR, editors. Perivascular tumors. In: Enzinger and Weiss’s Soft Tissue Tumors. 4th ed. St Louis, Mo: Mosby; 2001.p.985–1001.
8. Netscher DT, Aburto J, Koepplinger M. Subungual Glomus Tumor. J Hand Surg Am. 2011 Dec;37(4):821-3.
9. Gandhi J, Yang SS, Hurd J. The anatomic location of digital glomus tumor recurrences. J Hand Surg Am. 2010 Jun;
35(6):986-9.
10. Roddy E. Revisiting the pathogenesis of podagra: why does gout target the foot?. J Foot Ankle Res. 2011;4(1):13. doi:10.1186/1757-1146-4-13
11. Love JG. Glomus tumors: diagnosis and treatment. Mayo Clin Staff Proc. 1944;19:113–6.
12. Roan TL, Chen CK, Horng SY, Hsieh JH, Tai HC, Hsieh MH, et al. Surgical technique innovation for the excision of subungual
glomus tumors. Dermatol Surg. 2011;37:259–62
13. Vasisht B, Watson HK, Joseph E, Lionelli GT. Digital glomus tumors: A 29-year experience with a lateral subperiosteal approach. Plast Reconstr Surg. 2004;114:1486–9.
14. McDermott EM, Weiss AP. Glomus Tumors. J Hand Surg Am. 2006;31:1397-1400
15. Caroll RE, Berman AT. Glomus tumors of the hand: Review of literature and report on 28 cases. J Bone Joint Surg Am.
1972;54:691-703
16. Schiefer TK, Parker WL, Anakwenze OA, Amadio PC, et al. Extra digital glomus tumors: a 20-year experience. Mayo Clin
Proc. 2006;81:1337–1344
17. Strahan J, Bailie HW. Glomus Tumor. A review of 15 cases. Br J Surg. 1972;59:91–93
18. Trehan SK, Soukup DS, Mintz DN, Perino G, Ellis SJ. Glomus Tumors in the Foot: Case Series. Foot Ankle Spec. 2015 Dec;8(6):460–5.
19. Van Geertruyden J, Lorea P, Goldschmidt D, de Fontaine S, Schuind F, Kinnen L, Ledoux P, Moermans JP. Glomus tumours
of the hand. A retrospective study of 51 cases. J Hand Surg Br. 1996 Apr;21(2):257–60.
20. Hildreth DH. The ischaemia for glomus tumors: a new diagnostic test. Rev. Surg. 1970;27:147–148.
21. Bao-guo S, Wu Yun-tao W, Jia-Zhen L. Glomus tumours of the hand and foot. International Orthopaedics. 1997 Jan; 20(6):339–341.
22. Mohler DG, Lim CK, Martin B. Glomus tumor of the plantar arch: a case report with magnetic resonance imaging findings.
Foot Ankle Int. 1997 Oct;18(10):672–4.
23. Matsunaga A, Ochiai T, Abe I, et al. Subungual glomus tumour: evaluation of ultrasound imaging in preoperative assessment. Eur J Dermatol. 2007 Jan-Feb;17(1):67–9.
24. Chen SH, Chen YL, Cheng MH, Yeow KM, Chen HC, Wei FC. The use of ultrasonography in preoperative localization
of digital glomus tumors. Plast Reconstr Surg. 2003 Jul;112(1):115-9.
25. Fornage BD. Glomus tumors in the fingers: diagnosis with US. Radiology. 1988 Apr;167(1):183-5.
26. Cha SM, Shin HD, Park YC. Surgical Resection of Occult Subungual Glomus Tumors: Cold Sensitivity and Sonographic Findings. Ann Plast Surg. 2018 Oct;81(4):411- 415.
27. Al-Qattan MM, Al-Namla A, Al-Thunayan A, Al-Subhi F, El-Shayeb AF. Magnetic resonance imaging in the diagnosis
of glomus tumours of the hand. J Hand Surg Br. 2005 Oct; 30(5):535-40.
28. Mundada P, Becker M, Lenoir V, Stefanelli S, Rougemont AL, Beaulieu JY, et al. High resolution MRI of nail tumors
and tumor-like conditions. Eur J Radiol. 2019 Mar;112:93-105.
29. Lee SH, Roh MR, Chung KY. Subungual glomus tumors: surgical approach and outcome based on tumor location.
Dermatol Surg. 2013 Jul;39(7):1017-22.
30. Tada H, Hirayma T, Takemitsu Y. Prevention of postoperative nail deformity after subungual glomus resection. J Hand Surg Am. 1994;19:500–3.
31. Grover C, Khurana A, Jain R, Rathi V. Transungual surgical excision of subungual glomus tumour. J Cutan Aesthet Surg.
2013;6(4):196-203. doi:10.4103/0974-2077.123401
32. Li TS, Choong MY, Wu CI, Chen HC, Chung KC. Autologous fat graft to restore nail bed contour following resection of a subungual glomus. J Hand Surg Am. 2011;36:726–8.
33. Kim YJ, Kim DH, Park JS, Baek JH, Kim KJ, Lee JH. Factors affecting surgical outcomes of digital glomus tumour: a multicentre
study. J Hand Surg Eur Vol. 2018 Jul;43(6):652-658.
34. Gandhi J, Yang SS, Hurd J. The anatomic location of digital glomus tumor recurrences. J Hand Surg Am. 2010;35:986–9.
Published
2022-01-31
How to Cite
Dr Pranav Agrawal, Dr Rajesh Gandhi, Dr Gaurav Agrawal. (2022). Glomus Tumor - A Delayed Diagnosis, Yet Simple Cure: Case Reports. The Indian Practitioner, 75(1), 33-40. Retrieved from https://articles.theindianpractitioner.com/index.php/tip/article/view/1301
Section
Case Reports
