Orthopedic Surgery for Glomus Tumor Workup
- Author: Seema N Varma, MD; Chief Editor: Harris Gellman, MD more...
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]
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.
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). Because the lesion is richly vascularized, it demonstrates marked contrast enhancement on MRI performed after an intravenous injection of gadolinium-based contrast material.
Magnetic resonance angiography (MRA) is especially helpful in diagnosing small lesions that may be missed with other imaging studies.[19, 24]
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.
Glomus tumor cells stain positively for smooth-muscle actin and weakly express desmin. These cells have also been shown to express CD34.
Glomus tumors with malignant potential may show nuclear atypia, mitotic activity, or necrosis.
Chou T, Pan SC, Shieh SJ, Lee JW, Chiu HY, Ho CL. Glomus Tumor: Twenty-Year Experience and Literature Review. Ann Plast Surg. 2016 Mar. 76 Suppl 1:S35-40. [Medline].
Wood W. On painful subcutaneous tubercle. Edinburgh Med Surg J. 1812. 8:283-91.
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. 2001 Jan. 25(1):1-12. [Medline].
Wetherington RW, Lyle WG, Sangüeza OP. Malignant glomus tumor of the thumb: a case report. J Hand Surg [Am]. 1997 Nov. 22(6):1098-102. [Medline].
Chatterjee JS, Youssef AH, Brown RM, Nishikawa H. Congenital nodular multiple glomangioma: a case report. J Clin Pathol. 2005 Jan. 58(1):102-3. [Medline].
Maxwell GP, Curtis RM, Wilgis EF. Multiple digital glomus tumors. J Hand Surg [Am]. 1979 Jul. 4(4):363-7. [Medline].
Nazerani S, Motamedi MH, Keramati MR. Diagnosis and management of glomus tumors of the hand. Tech Hand Up Extrem Surg. 2010 Mar. 14(1):8-13. [Medline].
Lee IJ, Park DH, Park MC, Pae NS. Subungual glomus tumours of the hand: diagnosis and outcome of the transungual approach. J Hand Surg Eur Vol. 2009 Oct. 34(5):685-8. [Medline].
Miyamoto H, Wada H. Localized multiple glomangiomas on the foot. J Dermatol. 2009 Nov. 36(11):604-7. [Medline].
Sanna M, Fois P, Pasanisi E, Russo A, Bacciu A. Middle ear and mastoid glomus tumors (glomus tympanicum): An algorithm for the surgical management. Auris Nasus Larynx. 2010 Apr 16. [Medline].
Bahk WJ, Mirra JM, Anders KH. Intraosseous glomus tumor of the fibula. Skeletal Radiol. 2000 Dec. 29(12):708-12. [Medline].
Carroll RE, Berman AT. Glomus tumors of the hand: review of the literature and report on twenty-eight cases. J Bone Joint Surg Am. 1972 Jun. 54(4):691-703. [Medline].
Pater TJ, Marks RM. Glomus tumor of the hallux: case presentation and review of the literature. Foot Ankle Int. 2004 Jun. 25(6):434-7. [Medline].
Sun BG, Yun-tao W, Jia-zhen L. Glomus tumours of the hand and foot. Int Orthop. 1996. 20(6):339-41. [Medline].
Van Geertruyden J, Lorea P, Goldschmidt D, de Fontaine S, Schuind F, Kinnen L. Glomus tumours of the hand. A retrospective study of 51 cases. J Hand Surg [Br]. 1996 Apr. 21(2):257-60. [Medline].
Hildreth DH. The ischemia test for glomus tumor: a new diagnostic test. Rev Surg. 1970 Mar-Apr. 27(2):147-8. [Medline].
Kishimoto S, Nagatani H, Miyashita A, Kobayashi K. Immunohistochemical demonstration of substance P-containing nerve fibres in glomus tumours. Br J Dermatol. 1985 Aug. 113(2):213-8. [Medline].
Love JG. Glomus tumors: diagnosis and treatment. Mayo Clin Proc. 1944. 19:113-6.
Connell DA, Koulouris G, Thorn DA, Potter HG. Contrast-enhanced MR angiography of the hand. Radiographics. 2002 May-Jun. 22(3):583-99. [Medline].
Drapé JL. Imaging of tumors of the nail unit. Clin Podiatr Med Surg. 2004 Oct. 21(4):493-511, v. [Medline].
Drapé JL, Idy-Peretti I, Goettmann S, Guérin-Surville H, Bittoun J. Standard and high resolution magnetic resonance imaging of glomus tumors of toes and fingertips. J Am Acad Dermatol. 1996 Oct. 35(4):550-5. [Medline].
Takemura N, Fujii N, Tanaka T. Subungual glomus tumor diagnosis based on imaging. J Dermatol. 2006 Jun. 33(6):389-93. [Medline].
Marchadier A, Cohen M, Legre R. [Subungual glomus tumors of the fingers: ultrasound diagnosis]. Chir Main. 2006 Feb. 25(1):16-21. [Medline].
Van Ruyssevelt CE, Vranckx P. Subungual glomus tumor: emphasis on MR angiography. AJR Am J Roentgenol. 2004 Jan. 182(1):263-4. [Medline].
Murray MR, Stout AP. The glomus tumor: investigation of its distribution and behavior, and the identity of its "epithelioid" cell. Am J Pathol. 1942. 18:183-203.
Hatori M, Aiba S, Kato M, Kamiya N, Kokubun S. Expression of CD34 in glomus tumors. Tohoku J Exp Med. 1997 Jul. 182(3):241-7. [Medline].
Barnes L, Estes SA. Laser treatment of hereditary multiple glomus tumors. J Dermatol Surg Oncol. 1986 Sep. 12(9):912-5. [Medline].
Gould EP. Sclerotherapy for multiple glomangiomata. J Dermatol Surg Oncol. 1991 Apr. 17(4):351-2. [Medline].
Rivers JK, Rivers CA, Li MK, Martinka M. Laser Therapy for an Acquired Glomuvenous Malformation (Glomus Tumour): A Nonsurgical Approach. J Cutan Med Surg. 2016 Jan. 20 (1):80-3. [Medline].
Siegle RJ, Spencer DM, Davis LS. Hypertonic saline destruction of multiple glomus tumors. J Dermatol Surg Oncol. 1994 May. 20(5):347-8. [Medline].
Kaylie DM, O'Malley M, Aulino JM, Jackson CG. Neurotologic surgery for glomus tumors. Otolaryngol Clin North Am. 2007 Jun. 40(3):625-49. [Medline].
Sanna M, De Donato G, Piazza P, Falcioni M. Revision glomus tumor surgery. Otolaryngol Clin North Am. 2006 Aug. 39(4):763-82, vii. [Medline].
Garg B, Machhindra MV, Tiwari V, Shankar V, Kotwal P. Nail-preserving modified lateral subperiosteal approach for subungual glomus tumour: a novel surgical approach. Musculoskelet Surg. 2015 May 10. [Medline].