A Curious Case of Paroxysmal Painful Thumb: Glomus Tumor Re-visited

Abstract

Glomus tumor is a rare and benign vascular hamartoma originating from the neuro-myo-arterial apparatus of the glomus body in the reticular dermis. Most commonly, it presents as a solitary subungual lesion which is often painful and triggered by changes in temperature and pressure on the affected digit. However, multiple glomus tumors both digitally and elsewhere on the body which may or may not be painful are also known to occur. Due to its cryptic location and varied presentation, there is an invariable delay in the diagnosis and management of this condition. We report a case of glomus tumor in a 28-year-old woman presenting with paroxysmal painful lesion over her right thumb for 5 years.

Keywords: Glomus body; Love’s sign; ildreth’s sign; magnetic resonance imaging.

Figure 1

Localized tender spot on right thumb located inferolateral in relation to the nail (Love’s sign)

Figure 2

MRI of the right thumb. A. T1 coronal for thumb. B. T1 axial. C. Post-contrast T1 fat saturated coronal image of the thumb. D. Post-contrast T1 fat saturated axial image of the thumb. MRI showed a focal soft tissue nodular thickening at subungual aspect of the thumb. On T1, the lesion was isointense to muscle. On post contrast, this lesion showed avid enhancement. Underlying bone was normal. Findings were suggestive of a benign hypervascular lesion

Figure 3

A. Trans-ungual approach to the tumor (black arrow) with exposure of nail bed and matrix after reflecting the nail plate and proximal nail fold. B. Excised tumor tissue. C. The nail plate and proximal nail fold re-positioned with the help of 4-0 non-absorbable sutures. D. Asymptomatic with well healed scar 3 months post-operatively

Figure 4

Photomicrograph of the excised lesion showing varying sized vessels (black arrows) surrounded by collarettes of glomus cells (blue arrow) (H&E, ×10)