Glomus tumor of the hand

Abstract

Background: Glomus tumors were first described by Wood in 1812 as painful subcutaneous tubercles. It is an uncommon benign neoplasm involving the glomus body, an apparatus that involves in thermoregulation of cutaneous microvasculature. Glomus tumor constitutes 1%-5% of all hand tumors. It usually occurs at the subungual region and more commonly in aged women. Its classical clinical triad consists of pain, tenderness and temperature intolerance, especially cold sensitivity. This study reviews 15 cases of glomus tumor which were analyzed according to its anatomic location, surgical approach and histologic findings.

Methods: Fifteen patients with subungual glomus tumors of the hand operated on between January 2006 and March 2013, were retrospectively reviewed. Patients were evaluated preoperatively with standard physical examination including ice cube test and Love's test. Diagnostic imaging consisted of ultrasonography, computed tomography, and magnetic resonance imaging. All procedures were performed with tourniquet control under local anesthesia. Eleven patients underwent excision using the transungual approach, 3 patients using the volar approach and 1 patient using the lateral subperiosteal approach.

Results: Total of 15 cases were reviewed. 11 tumors were located in the nail bed, 3 in the volar pulp and 1 in the radial aspect of the finger tip. After complete excision, patients remained asymptomatic in the immediate postoperative period. In the long term follow up, patients exhibited excellent cosmetic results with no recurrence.

Conclusions: Accurate diagnosis should be made by physical, radiologic and pathologic examinations. Preoperative localization and complete extirpation is essential in preventing recurrence and subsequent nail deformity.

Keywords: Glomus tumor; Hand; Neoplasms.

Fig. 1. Image of color Doppler ultrasonography

Color Doppler ultrasonographic image shows a tiny ovoid, hypervascular nodule beneath the nail, with focal bone erosion of the distal phalanx (white arrow).

Fig. 2. Axial gadolinium-enhanced fat-saturated T1-weighted image

Axial gadolinium-enhanced fat-saturated T1-weighted image shows a prominent enhancing nodule with subtle erosion at the distal phalanx (white arrow).

Fig. 3. Various methods of surgical approach

(A) Transungal approach, (B) lateral subperiosteal approach, (C) volar approach.

Fig. 4. Gross and pathologic feature of glomus tumor

(A) Gross appearance. (B) Tumor resection with a transungual approach. Pathologic features of a glomus tumor. (C) The tumor cell has a sharply punched-out rounded nucleus with amphophilic or pale eosinophilic cytoplasm (H&E, ×400). (D) The lacework of basement membrane around the tumor cells is accentuated with a periodic acid-Schiff stain (Periodic acid-Schiff stain, ×400).

Fig. 5. Gross and pathologic feature of glomangioma

(A) Gross appearance. (B) Tumor resection with careful preservation of the nail bed. (C) Pathologic features of glomangioma. The tumor has hemangioma-like multiple dilated blood vessels with surrounding clusters of glomus cells (H&E, ×400). (D) The dilated blood vessels are conspicuous in the immunohistochemical stain for CD34. The tumor cells show membranous reactivity for CD34 (Immunohistochemistry for CD34, ×400).

Fig. 6. Images showing pathologic features of glomangiomyoma

(A) The tumor is composed of proliferating spindle smooth muscle cells with dilated blood vessels as well as round glomus cells. Characteristically, the glomus cells undergo a transition to spindle smooth muscle cells (H&E, ×400). (B) The spindle smooth muscle cells and the round glomus cells are both positive for smooth muscle actin (immunohistochemistry for smooth muscle actin, ×400).