Glomus tumors: symptom variations and magnetic resonance imaging for diagnosis

Abstract

Background: The typical clinical symptoms of glomus tumors are pain, tenderness, and sensitivity to temperature change, and the presence of these clinical findings is helpful in diagnosis. However, the tumors often pose diagnostic difficulty because of variations in presentation and the nonspecific symptoms of glomus tumors. To the best of our knowledge, few studies have reported on the usefulness of magnetic resonance imaging (MRI) in diagnosing glomus tumors in patients with unspecific symptoms.

Methods: THE INCLUSION CRITERIA OF THIS STUDY WERE: having undergone surgery for subungual glomus tumor of the hand, histopathologic confirmation of glomus tumor, and having undergone preoperative MRI. Twenty-one patients were enrolled. The characteristics of the tumors and the presenting symptoms including pain, tenderness, and sensitivity to temperature change were retrospectively reviewed.

Results: Five out of 21 patients (23%) did not show the typical glomus tumor symptom triad because they did not complain of pain provoked by coldness. Nevertheless, preoperative MRI showed well-defined small soft-tissue lesions on T1- and T2-weighted images, which are typical findings of glomus tumors. The tumors were completely resected and confirmed as glomus tumor histopathologically.

Conclusions: Early occult lesions of glomus tumor in the hand may not be revealed by physical examination because of their barely detectable symptoms. Moreover, subungual lesions may be particularly difficult to evaluate on physical examination. Our cases showed that MRI offers excellent diagnostic information in clinically undiagnosed or misdiagnosed patients. Preoperative MRI can accurately define the character and extent of glomus tumor, even though it is impalpable and invisible.

Keywords: Glomus tumor; Hand; Neoplasm.

Fig. 1

Preoperative photo of case 1 The 45-year-old male patient had experienced localized pain and tenderness for 2 years, without pain provoked by coldness.

Fig. 2

Preoperative MRI of case 1 Preoperative magnetic resonance imaging (MRI) of case 1 (T2-weighted), which revealed a hyper-intense lesion (white arrow) with a hypo-intense rim.

Fig. 3

Intraoperative photo of case 1 Intraoperative photo of case 1, after excision of the mass on the subungual lesion. The mass on the fingertip was approximately 3 mm in diameter.

Fig. 4

Preoperative photo of case 2 This 78-year-old female patient suffered point pain, tenderness aggravated by cold irritation, and nail irregularity in the thumb. Treatment before with non-steroidal anti-inflammatory drugs, pain killers, and antibiotics did not alleviate the symptoms.

Fig. 5

Preoperative MRI of case 2 Preoperative magnetic resonance imaging (MRI) of case 2 (T2-weighted), which appeared as hyper-intense lesions (white arrow) on the thumb.

Fig. 6

Intraoperative photo of case 2 Intraoperative photo of case 2, after complete surgical excision.

Fig. 7

Histopathologic photo of case 2 The tumor was composed of compact nests of monotonous polygonal cells with rounded nuclei and eosinophilic cytoplasm (H&E, ×100).

Fig. 8

Histopathologic photo of case 2 The tumor was composed of compact nests of monotonous polygonal cells with rounded nuclei and eosinophilic cytoplasm (H&E, ×400).