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Orthopedic Surgery for Glomus Tumor Workup

  • Author: Seema N Varma, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Mar 11, 2016
 

Laboratory Studies

The diagnosis of glomus tumor is primarily clinical, and laboratory workup is usually not needed. If the diagnosis is uncertain in view of the patient's history and physical findings, imaging studies are needed to assess the distal phalanx and the distal interphalangeal joint. Various imaging modalities have been used to diagnose glomus tumors (see Imaging Studies).[19, 20, 21, 22]

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Imaging Studies

Results of plain radiography are often unremarkable, but radiographs may show a well-circumscribed osteolytic lesion with a sclerotic border or a soft-tissue mass causing bone erosion.

Computed tomography (CT) is indicated for accurately assessing tiny abnormalities of the cortex of the distal phalanx. CT scans demonstrate a nonspecific nodule or mass, either in the soft tissue or within the bone.

For the initial workup, color Doppler ultrasonography is an appropriate first test. Ultrasonography may be helpful for depicting a cystic or a vascular component of a tumor. Ultrasonography and Doppler study yield better visualization of the tumors than standard radiology does; however, these sonographic methods are highly operator-dependent.[23]

Magnetic resonance imaging (MRI) offers whole imaging of the soft parts of the nail unit and the underlying bone. MRI may be performed to localize the tumor before surgery. On T1-weighted images, a glomus tumor appears as a dark, well-delineated mass. T2-weighted images are best for visualizing glomus tumors, which appear as bright and well-delineated masses (see the image below).[21]  Because the lesion is richly vascularized, it demonstrates marked contrast enhancement on MRI performed after an intravenous injection of gadolinium-based contrast material.

Intraosseous glomus tumor appears as a bright, wel Intraosseous glomus tumor appears as a bright, well-delineated mass on a T2-weighted MRI.

Magnetic resonance angiography (MRA) is especially helpful in diagnosing small lesions that may be missed with other imaging studies.[19, 24]

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Histologic Findings

On gross examination, a glomus tumor appears as a well-encapsulated soft-tissue lesion. On microscopic evaluation, the tumor usually occurs at the dermal-subepidermal junction and consists of markedly hypertrophied elements of the normal glomus body surrounded by a fibrous capsule. A normal glomus body is made up of vascular structures, smooth-muscle cells, and nerve cells surrounded by uniform epithelioid cells, also known as glomus cells.[25]

Glomus tumor cells stain positively for smooth-muscle actin and weakly express desmin. These cells have also been shown to express CD34.[26]

Glomus tumors with malignant potential may show nuclear atypia, mitotic activity, or necrosis.

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Contributor Information and Disclosures
Author

Seema N Varma, MD Attending Physician, Division of Hematology and Oncology, Department of Medicine, Sanford R Nalitt Institute for Cancer and Blood Related Diseases, North Shore-Long Island Jewish Health System/Staten Island University Hospital; Hospice Medical Director, University Hospice, Staten Island University Hospital

Seema N Varma, MD is a member of the following medical societies: American College of Physicians, American Society of Hematology, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Coauthor(s)

Albert B Accettola, Jr, MD Clinical Associate Professor, Department of Orthopedic Surgery, New York University Medical Center; Consulting Staff, Orthopaedic Associates of New York, Healthcare Associates in Medicine, PC

Albert B Accettola, Jr, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Sanam Ahmed, MD Staff Physician, Department of Internal Medicine, Staten Island University Hospital

Sanam Ahmed, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Terenig Terjanian, MD Assistant Clinical Professor, Department of Medical Oncology, State University of New York Health Science Center, Brooklyn; Consulting Staff, Director of Hematology/Oncology Division, South Campus, Staten Island University Hospital

Terenig Terjanian, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Hematology, Medical Society of the State of New York, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ian D Dickey, MD, FRCSC Adjunct Professor, Department of Chemical and Biological Engineering, University of Maine; Consulting Staff, Adult Reconstruction, Orthopedic Oncology, Department of Orthopedics, Eastern Maine Medical Center

Ian D Dickey, MD, FRCSC is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Royal College of Physicians and Surgeons of Canada, British Columbia Medical Association, Canadian Medical Association

Disclosure: Received consulting fee from Stryker Orthopaedics for consulting; Received honoraria from Cadence for speaking and teaching; Received grant/research funds from Wright Medical for research; Received honoraria from Angiotech for speaking and teaching; Received honoraria from Ferring for speaking and teaching.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Timothy A Damron, MD David G Murray Endowed Professor, Department of Orthopedic Surgery, Professor, Orthopedic Oncology and Adult Reconstruction, Vice Chair, Department of Orthopedics, State University of New York Upstate Medical University at Syracuse

Timothy A Damron, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Society for Experimental Biology and Medicine, Orthopaedic Research Society, Children's Oncology Group, Musculoskeletal Tumor Society, American College of Surgeons, American Medical Association, Connective Tissue Oncology Society

Disclosure: Received research grant from: National Institutes of Health NIAMS; Orthopaedic Research and Education Foundation; Stryker; Cempra; Wright Medical<br/>Received income in an amount equal to or greater than $250 from: Stryker, Inc (Educational travel to Stryker sponsored meetings)<br/>Received royalty from Lippincott, Williams, and Wilkins for editing/writing textbook; Received grant/research funds from Genentech for clinical research; Received grant/research funds from Orthovita for clinical research; Received grant/research funds from National Institutes of Health for clinical research; Received royalty from UpToDate for update preparation author; Received grant/research funds from Wright Medical, Inc. for clinical research.

Acknowledgements

Vincent Ruggiero, MD Clinical Instructor, Orthopedic Surgery Residency Program, State University of New York Downstate; Consulting Staff, Orthopedic Associates of New York

Disclosure: Nothing to disclose.

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Glomus tumor.
Subungual hue seen with a superficial glomus tumor.
Intraosseous glomus tumor appears as a bright, well-delineated mass on a T2-weighted MRI.
 
 
 
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