Recurrent Bleeding Neck Mass: a Case Report

Abstract

An adult male presented to us with a recurrent, large bleeding tumour in the neck. We describe our approach to the patient, whose tumour was labelled as an atypical glomus on final histopathology. They are relatively uncommon in the head neck, and this case report with literature review is expected to add to our knowledge.

Keywords: Atypical glomus; Extradigital glomus.

Fig. 1

a The neck swelling was 20 × 10 cm, poorly compressible, non-pulsatile boggy mass, with a diffusely bleeding, ulcerated surface, arising from a sessile base from the entire right side of neck. b CECT of the neck showed a well-delineated heterogenously enhancing vascular lesion with dilated vessels supplied by external carotid. The deeper structures appeared normal. c Intraoperative picture showing clamp on external carotid artery. d PMMC markings—our myocutaneous flap was designed with the skin paddle around the nipple, instead of inferior and medial to it, keeping in mind the dimensions of the defect. e CECT neck done 1 year after surgery and RT does not show any recurrence. f Clinically, at 1-year follow-up, well-healed primary and donor sites

Fig. 2

a Gross specimen measured 22 × 19 × 10 cm with areas of necrosis. The cystic spaces varied in size from 0.5 to 1 cm. b Sections showed hypo- and hypercellular areas. The cells are arranged in perivascular pattern and in sheets displaying mild nuclear pleomorphism. Mitosis amounts to 10/10 hpf. (H&E ×100). c The cells were positive for SMA with Ki67 index > 20%. They were negative for CD34, CD31, and desmin. (Slide showing onlySMA positivity). d Sections showing Ki67 positivity> 20%. e ×400 magnification showing SMA positivity