Unusual Location of Pulp Glomus Tumor: A Case Study and Literature Review

Abstract

Glomus tumors are painful, benign tumors that develop from the glomus bodies. They account for less than 1% of tumors in hand, and less than 10% present in the pulp of the digits. Cold hypersensitivity, increased pinprick sensitivity, and paroxysmal pain are common glomus tumor symptoms. We describe a 27-year-old man who came with pain in the right little digit, confined to the pulp for 10 years. The tip of the finger was extremely sensitive to touch, and the pain worsened in a cold atmosphere. Upon palpation, no mass was recognized. There was pinpoint tenderness within the distal volar pulp of the little finger. MRI with a contrast of the right little digit showed a 2-mm enhancing lesion in the tip of the little finger. An incision was done over the volar plane of the little finger, removing the tumor bluntly. The tumor was found to be a glomus tumor after histologic evaluation. Glomus tumors of the volar pulp are notoriously hard to detect. Hence, the presence of localized pain in the volar tip for the finger should raise suspicion of the diagnosis of a glomus tumor, and surgical removal should be offered to relieve symptoms and avoid recurrence.

Fig. 1.

A contrast enhanced MRI revealed a round 2-mm soft tissue lesion in the volar ulnar aspect of the distal little finger. There was no bone invasion, and the rest of the soft tissue was normal.

Fig. 2.

An intraoperative image of the lesion after the 1-cm incision.

Fig. 3.

Histology findings. Photomicrograph showing clusters of oval-shaped perivascular glomus cells surrounding blood vessels (arrow). H/E stain X400. Photomicrograph showing clusters of oval-shaped perivascular glomus cells surrounding blood vessels. H/E stain X600.

Fig. 4.

Different methods of surgical approach for digital glomus tumor excision. A, Transungal method. B, Lateral subperiosteal method. C, Volar method.