Glomus tumor of the fingertips: A frequently missed diagnosis

Abstract

Background: Glomus tumors present as painful lesions, most commonly in the fingertips. These can present to outpatient clinics of multiple specialties.

Materials and methods: Retrospective review was performed of 37 patients diagnosed as having glomus tumor in the thumb or fingertips over a 10-year period. The data collected included demographics, presenting symptoms, duration, previous treatment history, physical examination, treatment, and recurrence. The data were presented by means of descriptive statistics.

Results: The mean duration of symptoms before presentation was 3.8 years (range 2 to 12 years). The mean age at presentation was 38 years (range 16 to 62 years), and female to male ratio was 21:16. Twenty-two patients had left-hand involvement; thumb 8, index finger 5, middle finger 5, ring finger 14, and little finger 5. Clinical and radiological assessments were made preoperatively. At presentation, 18 cases had nail changes, whereas 19 had no obvious nail changes - out of these, 4 had pulp involvement. The lesion involved the subungual region in 33 cases. The mean size of the lesion was 3.8 mm (range 2 to 10 mm). Thirty-six patients were found to have histopathologically proven glomus tumors, whereas in one no specific lesion was found on histopathological examination; this patient returned with recurrence of symptoms at 2-month follow-up. There was no other patient experienced recurrence of symptoms.

Conclusion: Early diagnosis of glomus tumors is important to avoid lengthy treatment delays, chronic pain, disuse syndromes, and psychiatric misdiagnoses.

Keywords: Digits; finger; glomus tumor; hand; misdiagnosis.

Figure 1

(a) Nail plate reflected and showing glomus tumor in subungual location of the right ring finger. (b) Excised glomus tumor from the subungual location

Figure 2

Glomus tumor of the pulp of left little finger

Figure 3

(a) The photomicrograph shows somewhat circumscribed tumor showing cords, nests of glomus cells surrounding intricate vascular network (H and E; ×40). Inset shows reticulin stain highlighting the rich vascular network. (b) Photomicrograph shows cuboidal monomorphic glomus cells with round nuclei. Intervening stroma is edematous, myxoid, and shows numerous mast cells. (H and E; ×200)

Figure 4

Scalloping of the distal phalanx of right ring finger (same patient shown in Figure 1)