Glomus Tumor

Summary

Glomus tumor is a rare and benign vascular tumor. The lesions are usually solitary but several
reports of multifocal tumors have been published.

The lesions present most frequently during the fourth and fifth decade of life although they can be
found in any age and at any site. The subungual tumors affect women three times more
commonly than men.
Clinically, glomus tumors are characterized by a triad of sensitivity to cold, localized tenderness
and severe intermittent pain. The pain can be excruciating and is described as a burning or
bursting.The exact cause of the pain is not completely understood, but nerve fibers containing the
pain neurotransmitter substance P have been identified in the tumor.
Radiologically, glomus tumors appear as well circumscribed osteolytic lesions. The lesion shows
either bone erosion or invasion depending on where it arises. A sclerotic border is present due to
the slowly enlarging mass. CT scan shows a non-specific subungual mass. T1 MRI is not as
useful for subungual lesions as it only demonstrates a dark, well delineated mass. Glomus tumors
appear as a very high and homogeneous signal intensity on T2 weighted images. MRI is useful
for the detection of lesions in the soft tissues. The radiological differential includes epidermal
inclusion cyst, enchondroma, chronic osteomyelitis, sarcoidosis, metastatic carcinoma, subungual
melanoma and osteoid osteoma.
Treatment of glomus tumors consists of surgical excision. Repair of the nail bed must be
performed after the removal of subungual lesions.
Complete Information on this Tumor
Introduction and Definition:

Glomus tumor is a rare and benign vascular tumor. The normal glomus unit is a neuromyoarterial
apparatus that functions to regulate skin circulation and is found subungually, on the finger tip
pulp, on the base of the foot and the rest of body in descending order. The most common site of
glomus tumors is subungual and 75% of the lesions occur in the hand.

Other sites include the palm, wrist, forearm and foot. Glomus tumor can occur near the tip of the
spine, where it may arise from the glomus coccygeum. Glomus tumors have also been described
in locations where the glomus body does not normally occur. Unusual sites include the patella,
bone, chest wall, eyelid, colon, rectum, cervix, and other sites. Glomus tumors rarely arise directly
from bone.

Incidence and Demographics:

The lesions present most frequently during the fourth and fifth decade of life although they can be
found in any age and at any site. The subungual tumors affect women three times more
commonly than men.
Symptoms and Presentation:

Clinically, glomus tumors are characterized by a triad of sensitivity to cold, localized tenderness
and severe intermittent pain. The pain can be excruciating and is described as a burning or
bursting.The exact cause of the pain is not completely understood, but nerve fibers containing the
pain neurotransmitter substance P have been identified in the tumor.

X-Ray Appearance and Advanced Imaging Findings:

Radiologically, glomus tumors appear as well circumscribed osteolytic lesions. The lesion shows
either bone erosion or invasion depending on where it arises. A sclerotic border is present due to
the slowly enlarging mass. CT scan shows a non-specific subungual mass. T1 MRI is not as
useful for subungual lesions as it only demonstrates a dark, well delineated mass. Glomus tumors
appear as a very high and homogeneous signal intensity on T2 weighted images. MRI is useful
for the detection of lesions in the soft tissues. The radiological differential includes epidermal
inclusion cyst, enchondroma, chronic osteomyelitis, sarcoidosis, metastatic carcinoma, subungual
melanoma and osteoid osteoma.
Histopathology findings:
Grossly, the tumors are usually less than one cm. in size, and appear as small red-blue nodulas.
The lesion appears as a localized dark red or blue lesion beneath the finger nail, but the
subungual lesions can be difficult to detect on clinical examination. Radiographs of the distal
phalanx show a small scalloped osteolytic defect with a sclerotic border. Under the microscope,
glomus tumors are found at the dermal and subdermal junction and have a fibrous capsule. They
are made of an afferent arteriole, anastomotic vessel, and collecting venule. These vascular
structures are surrounded by rounded uniform epithelioid cells with granular cytoplasm known as
glomus cells or pericytes. Also present are smooth muscle cells and non-myelinated nerve cells.
There is no pleomorphism or mitotic activity. There are three forms of glomus tumors: vascular,
myxoid and solid. The vascular form consists of mostly vessels with little epithelioid component.
The solid form has sheets of glomus cells with few vessels. Glomus tumors stain positive for the
smooth muscle marker actin.
Treatment Options for this Tumor:
Treatment of glomus tumors consists of surgical excision. Repair of the nail bed must be
performed after the removal of subungual lesions.
Outcomes of Treatment and Prognosis:
Relief of pain is usually intermediate after surgery.
Suggested Reading and Reference:
Johnson, DL et al., Intraosseous Glomus Tumor of the Phalanx: A Case Report, Journal of Hand
Surgery (American):18(6):1026-8, November, 1993. Kishimoto S et al., Immunohistochemical
demonstration of Substance-P containing nerve fibers in glomus tumors. Br J Dermatol 113:213,
1985. Murphey, MD et al., Musculoskeletal Angiomatous Lesions: Radiologic-Pathologic
Correlation, Radiographic, 15:893917, July, 1995. Takei, TR and EA Nalebuff, Extradigital
Glomlis Tumor, Journal of Hand Surgery (British), 20B(3):409-412, June, 1995. Sunderraj, S et
al., Primary Intra-Osseous Glomus Tumor, Histopathology, 14(5):532-536, May, 1989. Heys, SD
et al., Glomus Tumor: An Analysis of 43 Patients and Review of the Literature, British Journal of
Surgery, 79:345-347, April, 1992. Vandevender, DK and RA Daley, Benign and Malignant
Vascular Tumors of the Upper Extremity, Hand Clinics, 11 (2): 161 - 179, May, 1995. Huvos,
Andrew, Bone Tumors Diaonosis. Treatment and Prognosis, W.B. Saunders, Co., 1991.