A painful glomus tumor on the pulp of the distal phalanx

Abstract

A 52-year-old female patient presented with an 8-year history of progressively intense pain, cold sensitivity, and severe tenderness to palpation of the ulnar side of the tip of her right little finger. Subsequent diagnostic evaluation with ultrasonographic imaging revealed the presence of a glomus tumor in the tender area. Glomus tumors are benign, occurring in the vascular hamartomatous tubercles of the glomus body, which is a myoarterial apparatus typically found in the reticular dermis of the skin. Distal glomus tumors are relatively uncommon, and account for approximately 1% of all hand tumors. Most of them are located in the subungual area because of its high concentration of glomus bodies. We report a case of a glomus tumor with a typical triad of symptoms, yet with a rare location : on the pulp of the ulnar aspect of the distal phalanx of the right little finger.

Keywords: Finger; Glomus tumor; Pain.

Fig. 1

Longitudinal (right) and transverse (left) ultrasonograms of the right little finger show markedly hypoechoic about 4×6 mm sized mass-like lesion in the ulnar aspect of distal phalanx. Color doppler shows hypervascular mass.

Fig. 2

Preoperative and intraoperative photographs views of the lesion. A : Incision was made on the painful lesion after Love's pin test. B : The arrow point to the glomus tumor in its in situ location. The glomus tumor is in the pulp of the distal phalanx of right little finger. C : Gross appearance of the excised tumor.

Fig. 3

Histological sections of the tumor. A : The section demonstrates blood vessels surrounded by a proliferation of round cells in a fibrous stroma (H & E, ×100). B : The tumor is composed of multiple vascular channels lined by endothelial cells and aggregates of round cells with darkly staining round to ovoid nuclei and eosinophilic cytoplasm (H & E, ×400).