手指血管球瘤26例临床分析

目的　探讨手指血管球瘤的诊断和手术方法。方法　 1996年 1月 -2 0 0 2年 12月 ,对 2 6例手指血管球瘤进行诊治。术前 2 6例Love氏试验阳性 ,冷敏感试验阳性 ,2 0例Hildreth氏试验阳性 ,15例中 11例透光试验阳性 ,1例X线侧位片显示末节指骨有肿瘤压迹。全部病例均采取肿瘤切除手术。结果　术后随访 11个月～ 7年 9个月 ,无 1例肿瘤复发。 2 6例疼痛完全消失 ,术前阳性症状全部消失。 2 2例指甲生长良好 ,无明显畸形。结论　提高对血管球瘤的认识 ,有助于早期诊断 ,早期治疗 ,完整切除肿瘤是提高临床疗效的关键。     

Subungual glomus tumours of the hand: diagnosis and treatment of 14 cases.

A glomus tumour is a rare tumour of the hand, which presents with a classic triad of symptoms of temperature sensitivity, pain, and localised tenderness. We report a series of 14 patients with glomus tumours in the subungual region. There were four men and 10 women, whose mean age was 46 years (range 28-65). All patients complained of pain and localised tenderness and six of temperature sensitivity. The bony lesion was seen on radiographs in four patients. We used a transungual approach in all cases. A detailed history and clinical findings are the best way of making the diagnosis. The treatment of glomus tumour consists of complete excision and repair of the nailbed. Inadequate excision of the tumour usually causes local recurrence.     

A modified periungual approach for treatment of subungual glomus tumour.

Subungal glomus tumours are uncommon; the only treatment is complete surgical excision. Transungual approach is often preferred; however, secondary nail deformity may occur. Lateral periungual approach is used to avoid this complication, but this approach provides limited exposure and is used for peripheral lesion only. We describe a modified periungual approach which can be applied to central lesions. This approach can provide adequate exposure for complete excision of the subungual tumour while avoiding incision of the nail bed.     

女性手部血管球瘤的早期诊断及显微外科治疗

目的：探讨女性手部血管球瘤的临床表现,早期诊断及治疗方法。方法：选择30例女性手部血管球瘤患者,年龄18～48岁,平均35岁;病程3个月～3年。均为单指发病。早期行显微外科手术切除治疗。结果：30例中28例指甲有不同程度的局限性隆起,并可见指甲下有蓝紫色斑点状改变。18例X线片末节指骨有不同程度的受压表现。全部病例均可于指甲上找到明确并且固定的压痛点,术后患指疼痛均完全消失,经平均15个月随访,无疼痛复发病例。结论：甲下有蓝紫色斑点状改变及有固定压痛点,对女性手部血管球瘤患者有诊断意义,早期行显微外科手术切除是治疗此病有效的方法。     

39例手指血管球瘤的临床分析

目的 总结对手指血管球瘤的诊治疗效。方法 1997年1月至2002年5月对39例手指血管球瘤进行诊治。肿瘤生长于甲下33例，甲旁4例，指腹1例，指近节掌侧1例。39例患指有疼痛和压痛，Love征呈阳性，28例患指甲下有紫红色斑点，12例患指对冷刺激敏感。39例均作血管球瘤摘除术。结果 术后随访6—60个月，平均38．4个月。35例治愈，术前症状消失。4例术后3个月-5年肿瘤复发(10．26％)，再次接受手术治疗，3例获得治愈。1例第3次术后又复发，由于患指疼痛及甲板日月显畸形，施行第3次手术时，将肿瘤及全部甲床切除，用鱼际皮瓣修复示指末节背侧的软组织缺损，最终获得治愈。甲下血管球瘤术后27例(27／33，占81．82%)患指的指甲上有微小的纵沟。5例(5／33．占5.15％)指甲明显变形，1例(1／33，占3.03%)指甲损毁。结论 血管球瘤具有特征性的临床表现．结合影像学和病理表现，均可明确诊断。肿瘤切除术是一种有效的治疗方法。     

Glomus tumours of the hand: Review of literature

Glomus tumours are rare benign vascular neoplasms commonly found in the hand particularly in subungual region. Though, its aetiology remains largely unknown, several hypotheses have been made to explain the etiopathogenesis and cause of pain. These tumours usually present as a bluish or pinkish red discolouration of the nail plate with classical triad of localised tenderness, severe pain, and cold sensitivity. Nevertheless, differential diagnosis of other painful tumours, such as leiomyoma, eccrine spiradenoma, haemangioma, neuroma, osteochondroma, or mucous cyst should always be kept in mind while evaluating a patient with severe pain in the tip of the finger. In addition to the different clinical tests including Love's pin test, Hildreth's test, and trans-illumination test, imaging studies such as magnetic resonance imaging (MRI), ultrasonography, and radiography are often helpful in the diagnosis. Complete surgical excision is a must to get complete relief from the symptoms and to avoid recurrence. Several approaches have been described in the literature. Different surgeons may have different choices and may prefer one approach over the other depending on the anatomical location of the tumours. The purpose of this article is to review the important aspects of glomus tumours in hand concerning their aetiology, clinical presentation, diagnosis, management, and recurrence.     

Subungual Schwannoma: A Rare Location

BACKGROUND: Schwannoma is a benign tumor of neural tissue and usually develops in deeper soft tissue. Cutaneous involvement is uncommon, and a subungual location is extremely rare. In fact, it has not been previously reported. OBJECTIVE: To present a case of subungual schwannoma. METHOD: A 49-year-old man had a subungual tumor on his right thumb of 8 years duration. The lesion caused a mild stinging sensation in winter and grew slowly. The tumor was excised using a transungual approach. After closure, the wound was dressed with a trimmed original nail plate. RESULTS: The nail plate grew normally, and there was no recurrence 1 year postoperatively. CONCLUSION: We describe a case of schwannoma that developed in the subungual area of a thumb. Although schwannoma rarely develops in this area, it should be considered in the differential diagnosis of subungual tumor.     

Subungual Osteochondroma: A Case Report

Osteochondromas are among the most common bone tumors of the foot. However, they rarely occur in subungual locations. Clinically they appear as slow-growing masses causing deformity of the overlying nail. Here we present a case of subungual osteochondroma with characteristic clinical, radiologic, and histopathologic features. The lesion was successfully treated by total excision.     

Three select subungual pathologies: subungual exostosis, subungual osteochondroma, and subungual hematoma

Special attention has been given to the differences between subungual exostosis and subungual osteochondroma. Once a diagnosis has been made and symptoms persist, complete excision of the lesion with curettage of the base is the treatment of choice for both conditions. Subungual hematoma is an exquisitely painful condition that usually results from trauma, but may also be caused by systemic pathology, medication and drug reactions, and aging. Prompt decompression will significantly reduce pain and further damage to the nail bed and matrix. Radiographs must be taken because of the high incidence of associated distal phalangeal fracture. Patients must be warned that onycholysis, transient and permanent nail deformity, and infection are possible complications, even with the best treatment.     

Subungual exostosis in the hand.

Although it is thought to be a relatively common tumour, only 34 positively identified cases of subungual exostosis in the hand have been found in the literature to date. 16 further cases are reported, making this the largest published series. Seven cases presented with an incorrect diagnosis. An X-ray easily differentiates the tumour from an osteochondroma of the distal phalanx, a spike of bone from a crush injury, or a response to a penetrating injury called a turret exostosis. Removal of the deformed nail and excision of the mass from the distal phalanx produces a useful finger without pain, tender scar, or resultant nail deformity. No case of malignancy has ever been reported.     

Rare glomus tumor formation following trauma to the first digit

IntroductionGlomus tumors are rare and few cases are reported in the literature. They typically occur in females on the digits of the hands.Case presentationWe report a case of a 30 year-old woman who presented with a mass that developed on the distal tip of her right thumb after traumatic injury. Magnetic resonance imaging (MRI) was conducted and mass resection was performed. Histopathology confirmed that the mass was a glomus tumor.Clinical discussionClinical presentations of glomus tumors are typically non-specific, mainly consisting of a small mass with chronic pain, with a lengthy time to diagnosis and potentially improper management. MRI is the preferred diagnostic step, followed by curative surgical excision and pathological confirmation.ConclusionGlomus tumors can cause significant discomfort for patients, and clinicians should be aware of the rare diagnosis when treating painful masses on the extremities, as surgical excision is often curative.     

Two distinctive subungual pathologies: subungual exostosis and subungual osteochondroma

BACKGROUND: The purpose of this study was to present features that differentiate subungual exostosis from subungual osteochondroma. METHODS: We treated 11 patients for subungual masses. All were confirmed by radiographic and histologic evaluations to be subungual exostosis or subungual osteochondroma. The study patients comprised eight female and three male patients with a mean age at presentation of 18.7 years (range 1.5 to 70.9). In the five patients with subungual exostosis, three (60%) had a toe lesion, and two (40%) had a finger lesion. In the six patients with subungual osteochondroma, four (67%) had a toe lesion, and two (33%) had finger lesions. We analyzed the clinical features, including trauma history, the existence of infection before surgery, tumor recurrence, and postoperative nail deformity. RESULTS: In all patients, the lesions presented as an exophytic tumor of the nail apparatus, beneath the nail plate, which varied in size from 0.6 x 0.4 cm to 1.2 x 0.9 cm. Excision of these masses produced useful toes or fingers without pain, a tender scar, or nail deformity. Although nails were deformed preoperatively, they grew back without ridges or cracks within 3 to 5 months postoperatively. There were no recurrences based on clinical and radiographic evaluations, and both tumor types showed characteristic radiographic and histologic differences. CONCLUSIONS: Subungual exostosis and subungual osteochondroma are benign but have distinct osseous pathologies. We concluded that subungual exostosis is clinically, developmentally, radiographically, and histologically distinct from subungual osteochondroma.     

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 .     

On Glomus Tumors, Warts, and Razors

BACKGROUND: Occam's razor encourages ascribing a set of clinical findings to a single diagnosis. OBJECTIVE: To present a patient with a subungual wart and a glomus tumor of the same nail unit and to review the literature regarding these conditions. METHODS: We describe a 58-year-old female with a 2-year history of nail dystrophy and related symptoms that were initially attributed to verruca but recalcitrant to extensive therapies. RESULTS: Ultimately the persistence of her symptoms was found to be secondary to a subungual glomus tumor. CONCLUSION: Clinicians must maintain a high index of suspicion for the presence of multiple diagnoses to prevent the delay of appropriate management, particularly when symptoms do not respond to initial treatment.     

Protruded and nonprotruded subungual exostosis: Differences in surgical approach

Background:

In subungual exostosis surgery, repair of the damaged nail bed and surgical excision of the mass without damaging the nail bed is important. The ideal method of surgery is still unclear. This study is done to qualify the effects of different surgical methods on outcome measures in different types of subungual exostosis.

Materials and Methods:

Fifteen patients, operated with a diagnosis of subungual exostosis between January 2008 and June 2012, were evaluated. Protruded masses were excised with a dorsal surgical approach after the removal of the nail bed and nonprotruded masses were excised through a“fish-mouth” type of incision.

Results:

The mean age of the patients in protruded subungual exostosis group was 17.3 years (range 13-22 years) and this group consisting of seven female and two male patients. The patients were followed up for a mean of 14.1 ± 4.8 months. The mean age of the patients in the nonprotruded subungual exostosis group was 14.6 years (range 13-16 years) and consisting of six female patients. The patients were followed up for a mean of 11.6 ± 2.9 months. The results were positively affected by changing the surgical approach depending on whether or not the exostosis is protruded from the nail bed. All patients had healthy toe nails in the postoperative period without any signs of recurrence.

Conclusions:

In patients with a protruded subungual exostosis, the mass should be removed by a dorsal approach with the removal of the nail and injury to the nail bed should be repaired. In patients with a nonprotruded subungual exostosis, the mass should be excised through a “fish-mouth” type incision at the toe tip without an iatrogenic damage.     

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.     

Subungual exostosis: a review of 16 cases focusing on postoperative deformity of the nail

We reviewed the clinical features of 16 patients who underwent surgery for subungual exostosis, focusing on postoperative deformity of the nail. In 7 patients, the lesion did not destroy the nail bed and was excised with a fish-mouth-type incision. In 9 patients, the lesion destroyed the nail bed and was excised with a direct approach. In 5 of the 9 patients, artificial skin was applied after excision of the tumor because the defect of the nail bed was large. Good postoperative appearance of the nail was obtained by a fish-mouth-type incision when the tumor did not destroy the nail bed, although 2 patients had local recurrence. Onycholysis occurred postoperatively when the tumor destroyed the nail bed and the defect of the nail bed was large after excision of the tumor. Secondary nail bed reconstruction may be indicated in such cases with postoperative deformity of the nail.     

An Unusual Case of Periosteal Glomus Tumor at the Metacarpal Base Presenting as Type II CRPS: Case Report

Background: An unusual case involving a middle-aged male with a 9-year history of presumptive chronic regional pain syndrome (CRPS) and ulnar neuropathy was referred for failure in treatment. Methods: On presentation, the patient was requesting an amputation of his arm. However, work-up uncovered a periosteal extra-digital glomus tumor on the base of the small finger metacarpal. Results: Surgical excision of the lesion resulted in rapid resolution of his pain and normal hand function was ultimately restored. Conclusions: Glomus tumors account for up to 5% of all soft tissue tumors of the upper extremity, occurring most frequently within or adjacent to the nail bed. Time from onset of symptoms to correct diagnosis may not be established for many years, especially with atypical tumor locations. Although glomus tumors have been widely reported, atypical locations of these tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy. Furthermore, when evaluating a chronic pain patient, our findings support the opinion that assignment of the diagnosis of CRPS should only be a diagnosis of exclusion.