Glomangioma Supply from Profunda Femoris Artery in Peripheral Artery Disease

Abstract

This is a case report of a 5.6 cm glomangioma supplied by the femoral profunda artery in a 66-year-old male patient with severe peripheral artery disease. The patient complained of discomfort and mild pain at the place of the lesion and an accelerated growth rate in the last two months. A nodular mass located laterally on the left foot, elastic, covered with a thin skin, and mobile, was noted on the clinical exam. Doppler exam demonstrated an active vascular supply. CT angiography showed a femoral profunda artery blood supply and a severe asymptomatic bilateral peripheral artery disease (PAD). The lesion was removed entirely by surgery. A microscopy exam revealed a glomangioma. After surgery, the patient recovered unevenly. However, the patient experienced wound-healing issues that resolved after four weeks of surgery. Although the patient's PAD was severe, the lesion presented with a burst in dimensions weeks before surgery.

Keywords: glomangioma; peripheral artery disease; profonda femoris artery.

Figure 1

Left leg with a 5.6 nodular formation.

Figure 2

The CT angiographic scan of the lower limb shows the nodular formation with a vascular pedicle connected to the profound femoral artery. Blood vessels are also noticed inside (Supplemental Figure S1).

Figure 3

(a). Resected tumor showing various blood vessels, areas of necrosis, and clots. (b). Details of the resected tumor. (c). Histopathological exam offering dilatated venous channels with multiple rows of cuboidal glomus cells. Abnormal collections of glomus cells are noted. Unlike venous malformations, they present single or multiple rows surrounding cuboidal glomus cells. The glomus cells tested positively for vimentin and α-smooth-muscle actin. The three components needed for diagnosis were observed: glomus cells, blood vessels, and smooth muscle cells respectively: glomus cells: are small and uniform, round to oval shaped, with distinctive cell borders, centrally located punched-out nuclei, light eosinophilic or amphophilic cytoplasm; blood vessels: thin-walled, capillary sized, dilated; smooth muscle cells: elongated, mature looking.