Diagnosis and management of glomus tumors of the hand

Abstract

Aim and background: Glomus tumors are hamartomas that account for 1% to 5% of all soft tissue tumors of the hand. These tumors are usually benign. However, malignant degeneration can sometimes occur. They are usually characterized clinically by paroxysmal pain. Herein, we present our experience with 8 patients diagnosed with glomus tumors treated within the past 10 years.

Materials and methods: Eight patients who were diagnosed with glomus tumor of the hand were treated. Excruciating pain upon palpating the tumor was present in all the patients. Imaging studies such as magnetic resonance imaging were obtained but were only marginally helpful in locating and defining the surface topography for tumor resection. Meticulous dissection in a bloodless field and use of an operating microscope from the start of the operation were used for complete removal.

Results: Complete excision of the tumor with free margins was confirmed in all 8 cases. However, 1 of the patients had recurrence of the tumor, which presented 4 weeks postoperatively. No other recurrence was observed during the follow-up period (1 to 10 y). The postoperative course in all patients was uneventful except for deformed fingernail formation in 3 of the patients.

Conclusions: Glomus tumor is a rare disease; we encountered only 0.26% cases in our patients (3014 patients referring for hand surgery) during a 10-year period. Imaging studies are not very helpful. Preoperative marking of the maximum point of pain helps the surgeon somewhat to locate the tumor clinically. We believe that a bloodless operation field and magnification are essential prerequisites for successful surgery. We also note that pain alleviation and no pain recurrence 2 months after surgery clinically signify a cure. The possible development of permanent nail deformity should be anticipated and must be discussed with the patient preoperatively.