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Case Reports
. 2025 Apr 5;17(4):e81764.
doi: 10.7759/cureus.81764. eCollection 2025 Apr.

Novel Transungual Approach Using a Cement Spacer for a Recurrent Intramedullary Glomus Tumour of the Finger: A Case Report

Chia Wei Ooi  1 , Chia Hua Lim  1 , Elaine Zi Fan Soh  1 , Shalimar Abdullah  1 , Jamari Sapuan  1
Affiliations
Case Reports

Novel Transungual Approach Using a Cement Spacer for a Recurrent Intramedullary Glomus Tumour of the Finger: A Case Report

Chia Wei Ooi et al. Cureus. .

Abstract

Glomus tumours are rare benign epithelial and mesenchymal neoplasms of the glomus body, which primarily occur in the subungual area of fingers, characterized by excruciating pain, point tenderness, and cold sensitivity. Glomus tumours are also reported to be extradigital in almost every organ, which makes them difficult to diagnose due to their rarity. Delayed diagnosis commonly happens due to negative imaging from plain radiograph and ultrasound imaging. Early recognition of this disease with proper diagnosis and complete surgical excision is typically effective, leading to resolution of symptoms. Despite there is a chance of recurrence even with surgical excision in some cases, probably due to incomplete excision or the presence of another undiagnosed tumour at the beginning. We present a rare case of a recurrent intramedullary glomus tumour of the finger that persisted despite multiple surgical excisions. This case was managed using a novel transungual surgical approach, incorporating a cement spacer to provide structural support for the finger pulp following the removal of the diseased distal phalanx. We also review the surgical outcomes in this challenging scenario.

Keywords: bone cement; excision; glomus tumour; intramedullary; recurrent.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Magnetic resonance imaging: coronal view (A), sagittal view (B), and axial view (C).
A well-defined lesion was seen at the distal phalanx of the left index finger within the intramedullary region, measuring 2.7 x 2.1 x 3.2 mm, demonstrating hyperintense signal in T2W (circled with a red marker).
Figure 2
Figure 2. Intraoperative images of the excision of the glomus tumour using the transungal approach.
(A) Removal of the nail plate with longitudinal incision in the midline of the nail bed. (B) Bluish discoloration was seen over the dorsal cortex of the distal phalanx with defect from the previous surgical excision after dissecting the nail bed. (C) The diseased distal phalanx was excised distal to the flexor and extensor tendon attachment. (D) Complete excision of the diseased distal phalanx. (E-F) Diseased distal phalanx of the left index finger excised measuring 0.8 x 0.9 cm. (G) Bone cement was molded into shape of the tip of the distal phalanx and fill up the defect over the finger pulp.
Figure 3
Figure 3. (A) Placement of the bone cement to fill the void post excision of the distal phalanx. (B) Repair of the nail bed with Monosyn 6/0. (C) Nail plate anchored with a figure of 8 suture with Dafilon 4/0.
Figure 4
Figure 4. (A and B): Intensifier image of the left index finger with the proper placement of the bone cement over the tip of the distal phalanx supporting the pulp.
Figure 5
Figure 5. Histopathology slide of the resected distal phalanx.
(A) 2x magnification, (B) 40x magnification showing fragments of the tumor tissue composed of clusters of neoplastic cells exhibiting a uniform, monomorphic round nuclear contour with focal myxoid stroma consistent with a glomus tumour.
Figure 6
Figure 6. (A and B): Plain radiograph of left index finger showing malalignment of the bone cement over the distal phalanx impinging over the dorsal surface of the fingertip.
Figure 7
Figure 7. A schematic diagram of the glomus body in the dermis layer of the skin.
Source: Ref [5]
See this image and copyright information in PMC

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