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Dermatologic Manifestations of Glomus Tumor Clinical Presentation

  • Author: Jon H Meyerle, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: May 26, 2016
 

History

Patients with solitary glomus tumors usually have paroxysmal pain, which can be severe and can be exacerbated by pressure or temperature changes, especially cold. Multiple glomus tumors can also be painful, but this feature is less common, and the pain is usually not severe.

Patients with multiple lesions often seek medical attention because they are worried or have cosmetic concerns. Because multiple glomus tumors are inherited as an autosomal dominant condition, a family history of similar lesions may be helpful for diagnosis.

Extracutaneous sites have been reported, including involvement of the gastrointestinal tract, trachea, nerve, bone, mediastinum, liver, pancreas, kidney and ovary,[14, 15, 16, 17, 18] with a case of a malignant glomus tumor of the kidney having been reported.[13]

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Physical

Solitary glomus tumors have the following characteristics:

  • Blue or red blanchable papules or nodules in deep dermis or subcutis
  • Acral location, most commonly, especially subungual
  • Size usually smaller than 2 cm

The multiple variant is subdivided into regional or localized, disseminated, and congenital plaquelike forms, as follows:

  • Regional variant - Consists of blue-to-purple partially compressible papules or nodules that are grouped and limited to a specific area, most commonly to an extremity
  • Disseminated type - Consists of multiple lesions distributed over the body with no specific grouping; less common than the regional variant
  • Congenital plaquelike glomus tumors - Consist of either grouped papules that coalesce to form indurated plaques or clusters of discrete nodules; rarest variant of multiple glomus tumors

Two useful findings for diagnosing glomus tumors, particularly solitary painful glomus tumors (especially those under a nail), are the following[19, 20] :

  • Love test - Eliciting exquisite localized pain by applying pressure to the suspected areas with a pencil tip or pinhead
  • Hildreth sign - Reduction of pain and tenderness and reduction of tenderness with the Love test by inducing transient ischemia with a tourniquet
  • For a review of both the Love test, as well as the Hildreth sign, to include a simple clinical diagnostic algorithm, Tang et al's paper is a notable resource. [21]

Features of malignant glomus tumors, or glomangiosarcomas, may include the following[12] :

  • Size larger than 2 cm
  • Rapid growth
  • Deep soft tissue involvement
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Causes

Glomus tumors are neoplasms caused by a proliferation of glomus cells, which make up a portion of the glomus body. The initiating event for glomus cell proliferation is unknown. Some authors have postulated that trauma induces solitary subungual glomus tumors, although this theory is not well studied.

Most multiple glomus tumors, especially the disseminated form, are inherited in an autosomal dominant pattern with incomplete penetrance. Most hereditary glomangiomas are associated with defects in the glomulin gene, located on chromosome 1.[5, 6, 7]

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Contributor Information and Disclosures
Author

Jon H Meyerle, MD Assistant Professor, Department Dermatology, Uniformed Services University of the Health Sciences; Assistant Professor, Department of Dermatology, Johns Hopkins University School of Medicine; Chief, Immunodermatology, Walter Reed National Military Medical Center

Jon H Meyerle, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Erin L Spillane, MD Staff Dermatologist, Department of Dermatology, Womack Army Medical Center

Erin L Spillane, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Abby S Van Voorhees, MD Assistant Professor, Director of Psoriasis Services and Phototherapy Units, Department of Dermatology, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania

Abby S Van Voorhees, MD is a member of the following medical societies: American Academy of Dermatology, Women's Dermatologic Society, National Psoriasis Foundation, American Medical Association, Phi Beta Kappa, Sigma Xi

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbott for consulting; Partner received salary from Merck for management position; Received honoraria from Abbott for speaking and teaching; Received honoraria from Amgen for review panel membership; Received honoraria from Centocor for consulting; Received honoraria from Leo for consulting; Received none from Merck for other.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Omar P. Sangueza, MD, and Michael B. Reynolds, MD, to the original writing and development of this article.

References
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Glomus tumor.
Multiple glomus tumors.
Glomus tumor (4X). The tumor is composed of uniformly round, small, glomus cells with pale eosinophilic cytoplasm associated with conspicuous vasculature.
Glomus tumor (10X).
Glomangioma (2X). In this variant, blood vessels predominate.
Glomangioma (10X). Note the typical small, round glomus cells, often distributed in a monolayer or bilayer within the vessel walls.
 
 
 
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