Video Discription |
Glomus tumors are frequently associated with pain, tenderness and cold sensitivity.
The clinical diagnosis was made on the basis of medical history and MRI findings. The lesion was excised via a dorsolateral subungual approach, leading to the complete resolution of symptoms. Histology confirmed the lesion to be a glomus tumor.
Glomus tumors are painful subungual lesions. They produce a throbbing or lancinating local discomfort, cold-sensitivity, and severe pain following minor trauma. The diagnosis is confirmed by histology, but the clinical diagnosis is highly suggestive. Complete excision will usually relieve pain. Recurrence is common following incomplete resection.
#glomus tumor, #finger, #pathology, #hand surgery, pain
Introduction
Glomus tumors are rare, benign perivascular hamartomas of the glomus apparatus. In rare cases, large visceral lesions may be malignant [1].
Glomus tumors are usually under one centimeter in size and consist histologically of glomus bodies. They present as a faint, blue-red subungual papule associated with a classic triad of symptoms: local sensitivity, pain with cold exposure, and severe pain following minor trauma
Glomus tumors develop from modified glomus cells which are specialized smooth muscle cells that function as chemoreceptors . The normal function of glomus cells is to regulate blood flow in capillaries in response to changes in temperature.
Glomus tumors occur most frequently on the hand, especially in the subungual area, where glomus bodies are in high concentration. Glomus tumors may also occur in the lung, stomach, pancreas, liver, gastrointestinal or genitourinary tract
They are rarely malignant. Those that are cancerous tend to be large (over 2 centimeters, profound, and visceral. Giant intravenous glomus tumors have been reported
Glomus tumors grow slowly and can only be detected by MRI years following the first appearance of the symptoms
Subungual glomus tumors mostly occur in female patients while for tumors located in other areas of the body, there is no sex predilection
Complete excision is essential in the prevention of recurrence [9], and the only solution to relieve pain, given the fact that anti-inflammatory drugs have little or no effect [10].
Removal of the tumor is performed in a bloodless field, with tourniquet application, under loupe magnification . A bloody field can preclude complete excision and lead to recurrence When bone is involved, the bony portion of the lesion may either be excised or removed by curettage. En bloc resection is only necessary in the case of malignant tumors.
The surgical approach depends on the location of the lesion. For central subungual glomus tumors removal of the nail is often necessary . The diagnosis is confirmed by histology demonstrating capillaries lined with glomus cells. Glomus tumors are immunoreactive for smooth muscle actin and CD34 .
The best chance for cure is at the initial surgery and meticulous preparation, a bloodless field being imperative for tumor removal. In the event that the surgeon does not feel confident that the lesion can be “shelled out,” a peripheral and deep curettage may improve the cure rate.
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