eMedicine Specialties > Dermatology > Diseases of the Vessels

Glomus Tumor: Differential Diagnoses & Workup

Author: Michael B Reynolds, MD, Staff Physician, Associate Clinical Professor, Section of Dermatology, Medical College of Georgia
Contributor Information and Disclosures

Updated: Aug 7, 2009

Differential Diagnoses

Blue Nevi
Blue Rubber Bleb Nevus Syndrome
Kaposi Sarcoma
Leiomyoma
Maffucci Syndrome
Neurilemoma

Other Problems to Be Considered

Angioleiomyoma
Angiolipoma
Arteriovenous (AV) malformations
Congenital plaquelike blue nevus
Hemangioma
Melanoma
Spiradenoma
Tufted angioma

Workup

Laboratory Studies

  • Routine laboratory studies are not helpful in patients with glomus tumors.
  • The rare exception is in cases with widely disseminated lesions in which platelet sequestration is a concern. In these cases, a CBC count is indicated.

Imaging Studies

  • Imaging may aid in diagnosis, especially for subungual lesions.
  • In subungual glomus tumors, radiography reveals bony erosion in 14-60% of patients.
  • In addition, radiography may reveal an increased distance between the dorsum of the phalanx and the underside of the nail.
  • High-resolution MRI is probably the criterion standard for the imaging of glomus tumors, although nearly all tumors can be detected with standard MRI. A recent study reported 4 cases of chronic obscure finger-tip pain later diagnosed as subungual glomus tumors using high-resolution MRI.2
  • Ultrasonography has also been shown to be helpful.

Histologic Findings

  • Solitary and multiple glomus tumors have distinct histopathologic features.
  • Solitary lesions appear mostly as solid well-circumscribed nodules surrounded by a rim of fibrous tissue. They contain endothelium-lined vascular spaces surrounded by clusters of glomus cells. The glomus cells are monomorphous round or polygonal cells with plump nuclei and scant eosinophilic cytoplasm.
  • Multiple lesions are less well circumscribed and less solid-appearing than their solitary counterparts. Multiple lesions have the overall appearance of a hemangioma. They contain multiple irregular, dilated, endothelium-lined vascular channels that contain red blood cells. The vascular spaces are larger than those in solitary glomus tumors. Small aggregates of glomus cells are present in the walls of these channels and in small clusters in the adjacent stroma. Multiple glomus tumors have more narrow and focal aggregates of glomus cells than solitary lesions. The overall appearance of multiple glomus tumors accounts for their alternate name, glomangiomas.
  • Glomangiosarcomas resemble benign glomus tumors. However, glomangiosarcomas have more atypia, pleomorphism, and mitotic figures, and they have an invasive growth pattern. Most often, foci of benign glomus tumor are correlated with malignant lesions.

More on Glomus Tumor

Overview: Glomus Tumor
Differential Diagnoses & Workup: Glomus Tumor
Treatment & Medication: Glomus Tumor
Follow-up: Glomus Tumor
Multimedia: Glomus Tumor
References
Further Reading
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References

  1. Chou HP, Tiu CM, Chen JD, Chou YH. Glomus tumor in the stomach. Abdom Imaging. Jun 25 2009;[Medline].

  2. Fujioka H, Kokubu T, Akisue T, et al. Treatment of subungual glomus tumor. Kobe J Med Sci. Jun 5 2009;55(1):E1-4. [Medline].

  3. [Guideline] American Gastroenterological Association Institute. American Gastroenterological Association Institute medical position statement on the management of gastric subepithelial masses. Gastroenterology. Jun 2006;130(7):2215-6. [Medline].

  4. Barnes L, Estes SA. Laser treatment of hereditary multiple glomus tumors. J Dermatol Surg Oncol. Sep 1986;12(9):912-5. [Medline].

  5. Belanger SM, Weaver TD. Subungual glomus tumor of the hallux. Cutis. Jul 1993;52(1):50-2. [Medline].

  6. Boon LM, Mulliken JB, Enjolras O, Vikkula M. Glomuvenous malformation (glomangioma) and venous malformation: distinct clinicopathologic and genetic entities. Arch Dermatol. Aug 2004;140(8):971-6. [Medline].

  7. Chatterjee JS, Youssef AH, Brown RM, Nishikawa H. Congenital nodular multiple glomangioma: a case report. J Clin Pathol. Jan 2005;58(1):102-3. [Medline].

  8. Drape JL, Idy-Peretti I, Goettmann S, Guerin-Surville H, Bittoun J. Standard and high resolution magnetic resonance imaging of glomus tumors of toes and fingertips. J Am Acad Dermatol. Oct 1996;35(4):550-5. [Medline].

  9. 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. Jan 2001;25(1):1-12. [Medline].

  10. Glick SA, Markstein EA, Herreid P. Congenital glomangioma: case report and review of the world literature. Pediatr Dermatol. Sep 1995;12(3):242-4. [Medline].

  11. Goodman TF, Abele DC. Multiple glomus tumors. A clinical and electron microscopic study. Arch Dermatol. Jan 1971;103(1):11-23. [Medline].

  12. Gould EP. Sclerotherapy for multiple glomangiomata. J Dermatol Surg Oncol. Apr 1991;17(4):351-2. [Medline].

  13. Hiruta N, Kameda N, Tokudome T, et al. Malignant glomus tumor: a case report and review of the literature. Am J Surg Pathol. Sep 1997;21(9):1096-103. [Medline].

  14. Landthaler M, Braun-Falco O, Eckert F, Stolz W, Dorn M, Wolff HH. Congenital multiple plaquelike glomus tumors. Arch Dermatol. Sep 1990;126(9):1203-7. [Medline].

  15. Laymon CW, Peterson WC Jr. Glomangioma (glomus tumor). A clinicopathologic study with special reference to multiple lesions appearing during pregnancy. Arch Dermatol. Nov 1965;92(5):509-14. [Medline].

  16. Matsunaga A, Ochiai T, Abe I, Kawamura A, Muto R, Tomita Y, et al. Subungual glomus tumour: evaluation of ultrasound imaging in preoperative assessment. Eur J Dermatol. Jan-Feb 2007;17(1):67-9. [Medline].

  17. Requena L, Sangueza OP. Cutaneous vascular proliferations. Part III. Malignant neoplasms, other cutaneous neoplasms with significant vascular component, and disorders erroneously considered as vascular neoplasms. J Am Acad Dermatol. Feb 1998;38(2 Pt 1):143-75; quiz 176-8. [Medline].

  18. Siegle RJ, Spencer DM, Davis LS. Hypertonic saline destruction of multiple glomus tumors. J Dermatol Surg Oncol. May 1994;20(5):347-8. [Medline].

  19. Wetherington RW, Lyle WG, Sangueza OP. Malignant glomus tumor of the thumb: a case report. J Hand Surg [Am]. Nov 1997;22(6):1098-102. [Medline].

  20. Yen A, Raimer SS. Multiple painful blue nodules. Multiple glomus tumors (glomangiomas). Arch Dermatol. Jun 1996;132(6):704-5, 707-8. [Medline].

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Keywords

solitary glomus tumor, multiple glomus tumor, glomus cell, glomus body, glomangioma, Sucquet-Hoyer canal, modified smooth muscle cell, Hildreth sign, Love test

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Contributor Information and Disclosures

Author

Michael B Reynolds, MD, Staff Physician, Associate Clinical Professor, Section of Dermatology, Medical College of Georgia
Michael B Reynolds, MD is a member of the following medical societies: American Academy of Dermatology and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

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, American Medical Association, National Psoriasis Foundation, Phi Beta Kappa, Sigma Xi, and Women's Dermatologic Society
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Genentech Honoraria Consulting; Incyte Grant/research funds Other; Warner Chilcott Honoraria Consulting; Merck Salary Management position; Abbott  Speaking and teaching

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Christen M Mowad, MD, Associate Professor, Department of Dermatology, Geisinger Medical Center
Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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