Glomus Tumor in the Tarsal Tunnel: A Case Report

Glomus tumors are painful benign neoplasms. They commonly present in the hand and are mostly solitary lesions. We report a rare case of multiple glomus tumors in the lower leg. Moreover, 1 of the tumors was in the tarsal tunnel. Resection of the tumors resulted in the early diagnosis of glomus tumors and complete symptom relief. Because of its rarity, diagnosing an extradigital glomus tumor is difficult. Recognition of glomus tumors allows for an early diagnosis and resection, and preoperative magnetic resonance imaging helps in the detection of multiple lesions. Before resection, we considered tarsal tunnel syndrome in the differential diagnosis because of the symptoms and location of the tumor. Tarsal tunnel syndrome is a comparatively well-known disease in the foot. When tarsal tunnel syndrome is suspected, a glomus tumor should also be considered in the differential diagnosis.     

Glomus tumor of the glans penis

Glomus tumors of the penis are extremely rare. We report a patient with a solitary glomus tumor involving the penis. A 19-year-old man presented with a complaint of a recurrent painful penile mass. Resection of the lesion was performed. The pathologic diagnosis was glomus tumor of the glans penis. This case emphasizes the need for complete extirpation of the glomus tumor to avoid additional surgery.     

Successful Resection of locally infiltrative Glomus Tumor without pulmonary resection

IntroductionExtracutaneous glomus tumors occurring in the bronchus is very rare. Complete resection is basic procedure for treatment of glomus tumor. We present a glomus tumor of the left main bronchus that was successfully treated with rigid bronchoscopy followed by sleeve resection of the left main bronchus.Presentation of caseA 56-year-old man underwent two term resections to glomus tumor that originated from the left main bronchus. Firstly, we performed palliative resection with rigid bronchoscopy to make the correct diagnosis and evaluate the extent of the tumor. We subsequently performed curative resection. No complications or recurrence has occurred since the operation took place one year ago.DiscussionBefore curative resection, it is important to confirm the diagnosis and spread of the tumor. Therefore, palliative tumor resection by rigid bronchoscopy was useful to make the correct diagnosis, evaluate the extent of the tumor and open the bronchial lumen. After bronchoscopic treatment, curative pulmonary resection was performed and preservation of lung function was successful.ConclusionTwo term resections enabled us to make an accurate diagnosis and evaluation, thereby preserving respiratory function without pulmonary resection.     

Multiple glomus tumor: a case report and review of the literature.

Multiple glomus tumors are extremely rare and differ from the more common solitary glomus tumors in their clinical presentation and histological features. The authors report a case of multiple glomus tumors of the right hand in a 65-year-old man, its treatment, and a review of the features of this uncommon tumor. The tumor usually presents as a painful, firm, purplish, solitary nodule of the extremities, especially in the nail bed. Multiple glomus tumors are described as softer, more compressible, bluish nodules and they occur with less frequency than solitary tumors. They are often inherited in an autosomal dominant pattern. The authors present a case of multiple glomus tumors of the right hand, in which many small, painful, red papules were grouped in the right hypothenar region. The patient was treated by wide excision of the lesion and coverage of the defect with an ulnar artery forearm flap.     

32例甲外血管球瘤的临床分析

目的 总结甲外血管球瘤的临床特点及诊治方法 .方法 2000年1月至2008年4月对32例甲外血管球瘤进行诊治,其中30例单发,2例为两处病灶.均行局部病灶切除术.结果 术后随访2～98个月,平均46个月.所有患者术前症状全部消失,无复发病例.结论 甲外血管球瘤具有特征性的临床表现,即疼痛、压痛、冷激惹的三联征,因病变隐匿,诊断较困难,肿瘤切除术是唯一有效的治疗方法 .     

32例甲外血管球瘤的临床分析

目的 总结甲外血管球瘤的临床特点及诊治方法 .方法 2000年1月至2008年4月对32例甲外血管球瘤进行诊治,其中30例单发,2例为两处病灶.均行局部病灶切除术.结果 术后随访2～98个月,平均46个月.所有患者术前症状全部消失,无复发病例.结论 甲外血管球瘤具有特征性的临床表现,即疼痛、压痛、冷激惹的三联征,因病变隐匿,诊断较困难,肿瘤切除术是唯一有效的治疗方法 .     

32例甲外血管球瘤的临床分析

目的 总结甲外血管球瘤的临床特点及诊治方法 .方法 2000年1月至2008年4月对32例甲外血管球瘤进行诊治,其中30例单发,2例为两处病灶.均行局部病灶切除术.结果 术后随访2～98个月,平均46个月.所有患者术前症状全部消失,无复发病例.结论 甲外血管球瘤具有特征性的临床表现,即疼痛、压痛、冷激惹的三联征,因病变隐匿,诊断较困难,肿瘤切除术是唯一有效的治疗方法 .     

Multiple glomus tumors of the stomach with intravascular spread.

Gastric glomus tumors are characteristically benign solitary lesions. We present a case of multiple glomus tumors involving the stomach wall and perigastric adipose tissue. Histologically, the major portion of each tumor was composed of "typical" glomus cells arranged in a predominantly solid pattern. Cavernous hemangiomalike areas were present toward the periphery. The tumor cells were immunoreactive for alpha-smooth muscle actin, vimentin, laminin, and type IV collagen, but did not express desmin. There were several focal areas where the tumor cells had a signet-ring cell-like appearance, intermingled with cells having clear cytoplasm and hyperchromatic nuclei. Rare mitoses were noted. A striking feature was the presence of widespread but subtle extension of the glomocytes along venous channels subendothelially, with formation of intravascular nodules focally. The multiple separate tumor nodules found in perigastric fat are interpreted as having arisen in this manner. This entity is distinct from previously described typical and atypical solitary glomus tumors, glomangiosarcoma, and the syndrome of multiple glomus tumors of subcutaneous tissues. It may represent an early stage of development of the large, multilobulated glomus tumors that have rarely been reported to involve stomach and adjacent viscera.     

Multiple occurrences of different histologic types of the glomus tumor

A patient with 3 glomus tumors that occurred at different locations and times is presented. Two of the 3 tumors were of the same histologic type. The third tumor was a different type. Although it is rare, a solitary type of glomus tumor on initial presentation may exhibit multiple occurrences in the same patient.     

Clinical Features of Multiple Glomus Tumors

BACKGROUND While glomus tumors are usually solitary, multiple glomus tumors do occur. The purpose of this study was to review the clinical characteristics and outcomes in a series of patients with multiple glomus tumors presenting to our institution.
METHODS A retrospective review of patients with multiple glomus tumors seen at our institution over the past 25 years was performed.
RESULTS Twenty-two patients with multiple glomus tumors were identified. Initial diagnosis was blue rubber nevus syndrome and hemangioma in 10 and 7 patients, respectively. The mean duration from onset of symptoms until correct diagnosis was 14.6 years. Involvement of an extremity was noted in 90.9% of the patients. An autosomal dominant pattern of inheritance was noted in 13 of 22 patients. The classic triad of symptoms in solitary glomus tumors—pain, pinpoint tenderness, and cold hypersensitivity—was noted in only 1 of the 22 patients; pain and pinpoint tenderness were simultaneously identified in 14 patients, 8 with visible lesions but no symptoms. Symptoms were relieved by surgical excision in most patients.
CONCLUSION Patients with multiple glomus tumors are frequently misdiagnosed. Proper recognition and diagnosis would lead to improved management.     

On the etiology of glomus tumours

Summary Three unusual cases of solitary glomus tumours of the glomangioma type are described, and the etiology of solitary and multiple glomus tumours is discussed. This paper points out that the clinical entity of solitary glomus tumour is morphologically not a uniform structure, but has a varying histological appearence. Three histological types: mucous hyaline, solid and angiomatous (glomangiomas) have been described. The present findings of transition forms between solitary and multiple glomus and the reported variable relationship of multiple glomus tumours to the vascular system imply the possibility that the majority of solitary and a part of multiple glomus tumours arise by modification of the glomus bodies. The other theory which seeks to explain formation of the glomus tumours through the nevoid malformation of cutaneous blood vessels, seems to be relevant for the multiple glomus tumours with established vascular anastomoses and for the angiomatous forms of solitary glomus presented in this publication.Presented in part at the Fifth Meeting of the International Workshop on Vascular Anomalies (Hemangiomas and Vascular Malformations in the Field of Plastic Surgery), Milano, Italy. May 25th–26th 1984     

Glomus tumors of the fingers:Expression of vascular endothelial growth factor

Glomus tumors are uncommon,benign,small neuro-vascular neoplasms derived from glomus bodies in the reticular dermis. Glomus bodies are found throughout the body to regulate body temperature and skin circulation; however,they are concentrated in the fingers and the sole of the foot. The typical presentation is a solitary nodule in the subungual or periungual area of the distal phalanx. The primary treatment of choice is surgical removal. We investigated expression of vascular endothelial growth factor(VEGF) using immunohistochemistry in glomus tumors of the fingers. All five glomus tumor samples were positive for VEGF expression. VEGF immunoreactivity was largely localized to the cytoplasm of tumor cells,suggesting a contribution of VEGF to the vascularization of glomus tumors.     

Primary glomangiosarcoma of the lung: A case report

Background  

Glomus tumor is an uncommon neoplasm derived from cells of the neuromyoarterial glomus or glomus body. Most glomus tumours occur in the dermis and subcutaneous tissues. A case of a primary pulmonary glomus tumour originating in the right upper lobe is presented.     

Thymoma with synchronous pulmonary metastasis; report of a case

We report a resected case of thymoma with a solitary pulmonary metastasis. A 63-year-old woman had pointed out a solitary nodule in right lung field on chest X-ray. Computed tomography (CT) scan showed an anterior mediastinal tumor and a solitary lung nodule in the right lower lobe. Extended thymectomy and partial resection of right lung was performed. Pathological diagnosis showed an invasive thymoma (type B3) and a pulmonary metastasis. Post operative radiotherapy was administered and she is doing well 19 months following the resection. Thymoma with a solitary synclonous pulmonary metastasis is rare and is classified into Masaoka stage IVb. Generally, thymoma cases with distant metastasis are not indication for operation. But, if radical resection is possible, operation is recommended for good prognosis.     

Glomus tumor associated with pacinian hyperplasia--case report

Features of the glomus tumor and the relatively recently described pacinian hyperplasia are described including signs and symptoms, differential diagnosis and treatment. The role of trauma as an etiology is proposed. A case is reported and discussed in which the patient had a glomus tumor and pacinian hyperplasia in an index finger, and a glomus tumor in the small finger of one hand. Treatment of both entities was surgical excision.     

Glomus Tumor in a Segmental Bronchus: A Case Report

Glomus tumors originate from a neuroarterial structure called the glomus body, and grow mostly in soft tissue. It is rare for glomus tumors to develop in the respiratory system. The patient of the present case had an abnormal shadow in the right lung on chest X-ray, and computed tomography (CT) findings displayed a lung tumor in the right S6. Bronchoscopy was performed for the diagnosis of the lung tumor, and a polypoid bronchial tumor was unexpectedly found to occupy the right B3. The bronchial tumor was diagnosed as a glomus tumor, and the lung tumor was diagnosed as an adenocarcinoma. The bronchial glomus tumor was cauterized by argon plasma coagulation (APC). Three weeks after the cauterization by APC, the right lower lobectomy was performed for the treatment of the lung adenocarcinoma. The patient has remained disease free for 2 years.     

Glomus Tumor of Hoffa's Fat Pad and Its Management by Arthroscopic Excision

We present a rare case of glomus tumor of Hoffa''s fat pad in a 42-year-old woman. Magnetic resonance imaging findings along with the characteristic clinical picture led us to suspect a glomus tumor as the possible etiology. An ischemia test was found to be positive and this further substantiated our diagnosis. An arthroscopic excision was performed and the histology confirmed the diagnosis of glomus tumor of Hoffa''s fat pad. The patient responded well to the excision with immediate complete resolution of pain and she remains asymptomatic at the last follow-up after 15 months. To our knowledge, this is the second reported case of glomus tumor of Hoffa''s fat pad and the first ever to be managed by simple arthroscopic excision. The tumor poses a great challenge to an orthopedic surgeon. However, knowledge of its characteristic clinical presentation and the recognition of such a rare entity can help achieve an early diagnosis and timely management.     

Pulmonary and mediastinal glomus tumors--report of five cases including a pulmonary glomangiosarcoma: a clinicopathologic study with literature review

Pulmonary and mediastinal glomus tumors are rare lesions, with four previously reported primary pulmonary cases and three mediastinal cases. The authors report one mediastinal glomus tumor, a locally infiltrative type, and four pulmonary glomus tumors, including the first case of primary pulmonary glomangiosarcoma. These tumors show a variety of clinical and pathologic differences from the more common cutaneous variety, including later age at presentation, larger size, and more frequent atypical/malignant features. Mediastinal and pulmonary glomus tumors both have an average patient age at presentation of 45 years. However, compared with their pulmonary counterparts, mediastinal glomus tumors are less common, more often symptomatic, and are larger (average size, 5.4 cm). Additionally, mediastinal glomus tumors more often demonstrate malignant or atypical features. Pulmonary glomus tumors average 3.3 cm in greatest dimension, with the majority measuring less than 2.5 cm. The pulmonary glomangiosarcoma presented was large, measuring 9.5 cm, and showed increased mitotic count (9 mitoses/10 high-power fields), necrosis, cytologic atypia, and was associated with disseminated disease. Regardless of clinical symptoms, histologic features, and even metastases, the vast majority of all benign and malignant glomus tumors are indolent and cured surgically, with adjuvant therapy needed only for occasional patients with more advanced disease. The four patients with glomus tumors reported are currently alive and free of disease as of last follow up. The patient with the glomangiosarcoma developed widespread metastases and died of disease 68 weeks after initial therapy.     

血管球瘤28例诊治分析

目的　分析血管球瘤的发病机理 ,临床特点和误诊及治疗情况。方法　总结 2 8例术后病理检查证实的血管球瘤病例 ,对其主要临床表现及特征、误诊时间和病种、误诊的原因、误诊治疗的方式等进行分析。结果　非专业医师常因对本病的认识不足而误诊以致误治 ,误诊的病种和治疗方式多样。结论　血管球瘤较易误诊 ,彩色B超X线检查是诊断血管球瘤行之有效有效方法。而手术切除是治疗该病的惟一有效方法     

23例手指血管球瘤的诊断和显微手术治疗

目的总结手指血管球瘤的诊断和治疗经验。方法回顾性分析23例手指血管球瘤病例资料,肿瘤生长于甲下20例,侧甲襞1例,甲下皮2例,均行显微手术治疗。结果术后症状均消失,随访15例,平均10.2（3~15）月,无复发病例,外形满意。结论手指血管球瘤具有特征性的临床表现,仔细询问病史,体检,结合影像学检查,不难诊断;采用显微手术治疗,治愈率高,效果满意。