Dermatologic Manifestations of Glomus Tumor Clinical Presentation

Updated: Apr 04, 2019
  • Author: Vernon J Forrester, MD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

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. The classic triad of symptoms includes severe pain, with pinpoint localization, and cold hypersensitivity. While glomus tumors are classically red, blue, or purple, skin-colored glomus tumors have been reported and may delay diagnosis and complicate excision. Glomuvenous malformations (GVMs) are typically less painful than glomus tumors; however, they may become more painful with menstruation or pregnancy. While glomus tumors are most often found on the hand, the presence of characteristic symptoms should raise suspicion for glomus tumor in other locations, for example in the thigh or lower limb. [34] In the absence of pain, glomus tumor should still be considered in the differential diagnosis of nodules, even in uncommon locations such as the mouth. [35, 36] Additionally, subungual glomus tumors have been reported to rupture [32] and have also been reported to result in various nail changes, including color change, erythronychia, splitting, and thickening of the nail bed. [37] Therefore, any subungual nodule causing color and/or nail change should raise suspicion for glomus tumor.

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. [38, 39, 40, 41, 42] Cases of benign and malignant glomus tumors of the kidney have been reported. [19, 43, 44] Pulmonary involvement was described in a case report of a primary pulmonary glomus tumor in a segmental bronchus manifesting as obstructive pneumonia. [45] More recently, a case of glomus tumor was reported to cause a liver mass [46] and another case of a gastric glomus tumor was reported to cause upper gastrointestingal bleeding. [47]

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Physical Examination

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
  • Usually smaller than 2 cm

Glomuvenous malformation (GVM) 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 with a cobblestonelike appearance 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

Three useful findings for diagnosing glomus tumors, particularly solitary painful glomus tumors (especially those under a nail), are the following [48, 49, 50] :

  • Love test (>90% sensitivity) - Eliciting exquisite localized pain by applying pressure to the suspected areas with a pencil tip or pinhead (Also see Tang et al for a review and simple clinical diagnostic algorithm. [51] )
  • Hildreth sign (>90% sensitivity) - Reduction of pain and tenderness and reduction of tenderness with the Love test by inducing transient ischemia with a tourniquet (Also see Tang et al for a review and simple clinical diagnostic algorithm. [51] )
  • Cold sensitivity test - Considered positive when immersing the affected area in cold water elicits severe pain around the lesion

Features of malignant glomus tumors, or glomangiosarcomas, may include the following [5] :

  • Larger than 2 cm
  • Rapid growth
  • Deep soft-tissue involvement
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