Extra digital glomus tumor: A very rare cause of chronic abdominal wall pain

Abstract

Introduction: Glomus tumors are very rare benign vascular tumors, constituting less than 2% of soft tissue tumors. These tumors originate from the glomus body. 75% of these tumors occur in hand however rarely can be found in any body part.

Presentation of case: We here report a case of glomus tumor who presented with abdominal pain (constant and throbbing nature) and small swelling in the left hypochondrium. Pain was mostly spontaneous without any obvious cause, aggravated by cold and palpation. Ultrasonography parietal wall showed 27 × 22 × 21 mm hypoechoic lesion in the parietal wall with increased focal vascularity. Histopathological examination confirmed the diagnosis of glomus tumor.

Discussion: These are rare benign vascular tumors arising from the glomus bodies found anywhere in body. However 75% are found in hand mostly subungual region. Glomus tumor may show unusual clinical picture such as extra digital location, large size, deep soft tissue, visceral location, multi-centric or infiltrative growth pattern. These tumor commonly presents with a diagnostic triad of spontaneous pain, hypersensitivity to drop in temperature and pressure tenderness. Clinical diagnostic tests aide in diagnosis, including Love's test, Hildreth's test, Transillumination and the cold test. The clinical differential diagnosis of glomus tumor includes Raynaud's phenomenon, neuroma, gout, infection, peripheral neuropathy and radiculopathy.

Conclusion: Extra digital glomus tumor occur in any part of the body and should be put in differential diagnosis of abdominal pain when no obvious cause of pain is found. Surgical excision is the curative treatment of choice with rare recurrence.

Keywords: Abdominal pain; Abdominal wall; Glomus tumor.

Fig. 1

Ultrasonography imaging. Revealed 27 × 22 × 21 mm hypoechoic lesion in the muscular plan of abdominal wall with increased local blood flow.

Fig. 2

Histopathological examination revealed Glomus Tumor (2a - showing staining of vascular spaces by CD34, 2b - Small uniform round cells arranged in sheets and around vascular spaces, 2c - showing Smooth Muscle Antigen (SMA) positive glomus cells).