Successful Subungual Glomus Tumor Removal: A Case Report and Future Guidance on Diagnosis and Treatment
DOI:
https://doi.org/10.5195/ijms.2024.2486Keywords:
Case Report, Glomus Tumour, Hand Surgery, Benign Tumour, Rare Diseases, Glomus Tumor, Subungual Mass, Chronic Pain, MRI Diagnosis, Cold Sensitivity, Surgical Excision, Nail Bed Surgery, Histopathology, Benign TumorAbstract
Background: Glomus tumors are rare benign hamartomas of the glomus body that occur mostly – though not limited to - the distal phalanxes of the digits. This article provides a real-life example of successful rare disease identification and treatment. It also provides a guideline that may help serve as future guidance on diagnosis and treatment.
Case: A 41-year-old male came to our hospital presenting with a chief complaint of episodes of throbbing pain, which occurred spontaneously on the left thumb for the past two years. The pain had worsened in the past two weeks. The patient was positive for Hildreth’s, Love’s pin, and cold sensitivity tests. The previous x-ray showed no abnormalities in the left thumb. MRI found a hyperdense subungual lesion in the dorsal interphalangeal joint of the left thumb. We then performed an excision using the transungual approach. Histopathological findings found a relatively well-circumscribed lesion of the glomus apparatus absent of abnormal mitosis and necrosis. Two months after the excision, the patient reported no symptoms of recurrency, nail deformity, or other adverse outcomes.
Conclusion: Patients typically present a chief complaint of chronic paroxysmal throbbing nail pain that persists for years, increases following exposure to cold environments, and is disproportionately exacerbated with the slightest touch. Hildreth’s, Love’s Pin, and cold sensitivity tests are special examinations that elicit or suppress pain. As with most benign tumors, complete excision usually yields good results. Adequate knowledge about diagnostic methods will help patients achieve early intervention and cure.
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References
Morey VM, Garg B, Kotwal PP. Glomus tumors of the hand: Review of literature. J Clin Orthop Trauma [Internet]. 2016 Oct 1 [cited 2023 Jun 26];7(4):286–91. Available from: /pmc/articles/PMC5106475/
Jawalkar H, Maryada VR, Brahmajoshyula V, Kotha GK V. Subungual glomus tumors of the hand Treated by transungual excision. Indian J Orthop [Internet]. 2015 Jul 1 [cited 2023 Jun 27];49(4):403–7. Available from: /pmc/articles/PMC4510793/
Bordianu A, Zamfirescu D. The hidden cause of chronic finger pain: Glomus Tumor – A Case Report. J Med Life [Internet]. 2019 [cited 2023 Jun 3];12(1):30–3. Available from: /pmc/articles/PMC6527404/
Newman MJ, Pocock G, Allan P. Glomus tumour: A rare differential for subungual lesions. BMJ Case Rep [Internet]. 2015 May 14 [cited 2023 Jun 3];2015. Available from: /pmc/articles/PMC4434369/
Carroll RE, Berman AT. Glomus tumors of the hand: review of the literature and report on twenty-eight cases. J Bone Joint Surg Am [Internet]. 1972 [cited 2023 Jun 3];54(4):691–703. Available from: https://pubmed.ncbi.nlm.nih.gov/4341268/
Kim DH. Glomus tumor of the finger tip and MRI appearance. Iowa Orthop J [Internet]. 1999 [cited 2023 Jun 2];19:136–8. Available from: /pmc/articles/PMC1888624/
Tsiogka A, Belyayeva H, Sianos S, Rigopoulos D. Transillumination: A Diagnostic Tool to Assess Subungual Glomus Tumors. Ski Appendage Disord [Internet]. 2021 Apr 1 [cited 2023 Jun 27];7(3):231–3. Available from: /pmc/articles/PMC8138143/
Al-Qattan MM, Al-Namla A, Al-Thunayan A, Al-Subhi F, El-Shayeb AF. Magnetic resonance imaging in the diagnosis of glomus tumors of the hand. J Hand Surg Am [Internet]. 2005 Oct [cited 2023 Jun 25];30(5):535–40. Available from: https://pubmed.ncbi.nlm.nih.gov/16085343/
Bargon CA, Mohamadi A, Talaei-Khoei M, Ring DC, Mudgal CS. Factors associated with requesting magnetic resonance imaging during the management of glomus tumors. Arch Bone Jt Surg [Internet]. 2019 Sep 1 [cited 2023 Jun 25];7(5):422–8. Available from: /pmc/articles/PMC6802551/
Chou T, Pan SC, Shieh SJ, Lee JW, Chiu HY, Ho CL. Glomus tumor twenty-year experience and literature review. Ann Plast Surg [Internet]. 2016 [cited 2023 Jun 25];76:S35–40. Available from: https://pubmed.ncbi.nlm.nih.gov/26808758/
Fazwi R, Ann Chandran P, Ahmad TS. Glomus Tumour: A Retrospective Review of 15 Years Experience in A Single Institution. Malaysian Orthop J [Internet]. 2011 Nov [cited 2023 Jun 25];5(3):8–12. Available from: https://pubmed.ncbi.nlm.nih.gov/25279028/
Equator. Guidelines & Checklist. J Perinat Med [Internet]. 1987 Jan;15(2):213–6. Available from: https://static1.squarespace.com/static/5db7b349364ff063a6c58ab8/t/5db7bf175f869e5812fd4293/1572323098501/CARE-checklist-English-2013.pdf
Zampeli F, Terzidis I, Bernard M, Ochi M, Pappas E, Georgoulis A. Ganglion Cyst. Anterior Cruciate Ligament Reconstr Basic Sci Second Ed [Internet]. 2023 Jul 17 [cited 2023 Dec 17];431-436.e2. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470168/
Shin DK, Kim MS, Kim SW, Kim SH. A painful glomus tumor on the pulp of the distal phalanx. J Korean Neurosurg Soc [Internet]. 2010 Aug [cited 2023 Jun 2];48(2):185–7. Available from: /pmc/articles/PMC2941867/
Shepherd JT, Rusch NJ, Vanhoutte PM. Effect of cold on the blood vessel wall. Gen Pharmacol [Internet]. 1983 [cited 2023 Jun 2];14(1):61–4. Available from: https://pubmed.ncbi.nlm.nih.gov/6131011/
MASSON P. Le glomus neuromyoartérial des régions tactiles et ses tumeurs. Lyon Chil [Internet]. 1924 [cited 2023 Jun 2];21:257–80. Available from: https://cir.nii.ac.jp/crid/1571980075959511296.bib?lang=en
Tuncali D, Cemal Yilmaz A, Terzioglu A, Aslan G. Multiple occurrences of different histologic types of the glomus tumor. J Hand Surg Am [Internet]. 2005 Jan [cited 2023 Jun 2];30(1):161–4. Available from: https://pubmed.ncbi.nlm.nih.gov/15680574/
Looi KP, Teh M, Pho RWH. An unusual case of multiple recurrence of a glomangioma. J Hand Surg Am [Internet]. 1999 [cited 2023 Jun 2];24 B(3):387–9. Available from: https://pubmed.ncbi.nlm.nih.gov/10433466/
Love JG. Glomus Tumors: Diagnosis and Treatment. In: InProc Staff Meet Mayo Clinic. 1994. p. 113–6.
Kwan Tang CY, Tipoe T, Fung B. Where is the lesion? Glomus tumours of the hand. Arch Plast Surg [Internet]. 2013 Sep [cited 2023 Jun 25];40(5):492–5. Available from: /pmc/articles/PMC3785579/
Yii NW, Elliot D. Hildreth’s test is a reliable clinical sign for the diagnosis of glomus tumors. J Hand Surg Am [Internet]. 2002 [cited 2023 Jun 25];27 B(2):157–8. Available from: https://pubmed.ncbi.nlm.nih.gov/12027491/
Netscher DT, Aburto J, Koepplinger M. Subungual glomus tumor. J Hand Surg Am [Internet]. 2012 [cited 2023 Jun 25];37(4):821–3. Available from: https://pubmed.ncbi.nlm.nih.gov/22192165/
Kabakas F, Ugurlar M, Ozcelik I, Mersa B, Purisa H, Sezer I. Surgical treatment of subungual glomus tumors: Experience with lateral subperiosteal and transungual approaches. Hand Microsurg. 2016;5(2):70.
Garg B, Machhindra M V., Tiwari V, Shankar V, Kotwal P. Nail-preserving modified lateral subperiosteal approach for subungual glomus tumour: a novel surgical approach. Musculoskelet Surg [Internet]. 2016 Apr 1 [cited 2023 Jun 26];100(1):43–8. Available from: https://link.springer.com/article/10.1007/s12306-015-0374-z
Mortada H, Alrabah R, Kattan AE. Unusual Location of Pulp Glomus Tumor: A Case Study and Literature Review. Plast Reconstr Surg - Glob Open [Internet]. 2022 Mar 17 [cited 2023 Jun 26];10(3):E4206. Available from: https://journals.lww.com/prsgo/Fulltext/2022/03000/Unusual_Location_of_Pulp_Glomus_Tumor__A_Case.30.aspx
Senhaji G, Gallouj S, El Jouari O, Lamouaffaq A, Rimani M, Mernissi FZ. Rare tumor in unusual location - Glomus tumor of the finger pulp (clinical and dermoscopic features): A case report. J Med Case Rep [Internet]. 2018 Jul 8 [cited 2023 Jun 26];12(1):1–5. Available from: https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-018-1721-0
Binesh F, Akhavan A, Zahir ST, Bovanlu TR. Clinically malignant atypical glomus tumour. BMJ Case Rep [Internet]. 2013 [cited 2023 Jun 27];2013. Available from: /pmc/articles/PMC3603905/
Folpe AL, Fanburg-Smith JC, Miettinen M, Weiss SW. Atypical and malignant glomus tumors: Analysis of 52 cases, with a proposal for the reclassification of glomus tumors. Am J Surg Pathol [Internet]. 2001 [cited 2023 Jun 27];25(1):1–12. Available from: https://pubmed.ncbi.nlm.nih.gov/11145243/
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