Orthopedic Surgery for Glomus Tumor Differential Diagnoses

Updated: Apr 29, 2020
  • Author: Seema N Varma, MD; Chief Editor: Harris Gellman, MD  more...
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DDx

Diagnostic Considerations

Intraosseous glomus tumors should be included in the differential diagnosis of bone lesions. Plain radiography depicts these tumors as well-circumscribed, punched-out lesions with a sclerotic rim, especially in those arising in the finger.

Differential diagnoses of intraosseous glomus tumors can include the following entities:

Epidermal inclusion cysts are most commonly associated with trauma in superficial bones such as the calvaria, phalanx, hand, and foot. They are caused by the implantation of epithelium under the skin, which leads to the formation of cysts with secondary bone erosion. Pain over the lesion is common. However, point tenderness and sensitivity to cold, as observed with the classic glomus tumor, may not be present.

Enchondroma most often affects the cartilage that lines the inside of the bones. The bones that this benign tumor most commonly involves are the miniature long bones of the hands and feet. However, this lesion may also affect other bones, such as the femur, humerus, and tibia.

Osteoid osteoma is a benign bone lesion that is usually found in the diaphyses and the metaphyses of long bones, particularly at the distal end. It typically causes dull pain, which is worst at night and which lasts 20-30 minutes. The classic radiologic appearance of an osteoid osteoma is that of a radiolucent nidus surrounded by a dramatic, reactive sclerosis in the cortex of the bone. The four diagnostic features are as follows:

  • Sharp round or oval lesion
  • Diameter less than 2 cm
  • Homogeneously opaque center
  • Small area of peripheral radiolucency