Orthopedic Surgery for Glomus Tumor Workup

  • Author: Seema N Varma, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Mar 5, 2012
 

Laboratory Studies

The diagnosis of glomus tumor is primarily clinical, and laboratory workup is usually not needed.

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Imaging Studies

General imaging

If diagnosis is uncertain given the patient's history and physical findings, imaging studies are needed to assess the distal phalanx and the distal interphalangeal joint. A number of imaging studies have been used to diagnose glomus tumors, as described below.[18, 19, 20, 21]

Plain radiography

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.

CT scanning

CT is indicated to accurately assess 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.

Ultrasonography

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 improve visualization of the tumors, as compared with standard radiology. However, these sonographic methods are operator dependent.[22]

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, as depicted below.[20]

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

Because the lesion is richly vascularized, it demonstrates marked contrast enhancement on MRIs obtained after an intravenous injection of gadolinium-based contrast material.

Magnetic resonance angiography

Magnetic resonance angiography (MRA) is especially helpful in diagnosing small lesions that may be missed with other imaging studies.[18, 23]

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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.[24]

Glomus tumor cells stain positively for smooth muscle actin and weakly express desmin. These cells have also been shown to express CD34.[25]

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

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

Disclosure: Nothing to disclose.

Coauthor(s)

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 Clinical Oncology, American Society of Hematology, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Albert B Accettola, Jr, MD  Clinical Associate Professor, Department of Orthopedic Surgery, New York University Medical Center; Consulting Staff, Orthopedic 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, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

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.

Specialty Editor Board

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, American College of Surgeons, American Medical Association, Children's Oncology Group, Connective Tissue Oncology Society, Musculoskeletal Tumor Society, Orthopaedic Research Society, and Society for Experimental Biology and Medicine

Disclosure: Lippincott, Williams, and Wilkins Royalty Editing/writing textbook; Genentech Grant/research funds Clinical research; Orthovita Grant/research funds Clinical research; National Institutes of Health Grant/research funds Clinical research

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

Disclosure: Medscape Salary Employment

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, British Columbia Medical Association, Canadian Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Stryker Orthopaedics Consulting fee Consulting; Cadence Honoraria Speaking and teaching

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

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

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, and Arkansas Medical Society

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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