Glomus tumour

The glomus tumour was first described about 200 years ago as a painful, subcutaneous 'tubercle'. Several cases were described as 'malignant angiosarcomas' or 'colloid sarcomas'. Seventy-five per cent of glomus tumours occur in the hand, especially in the finger tips and particularly the subungual area. Between 1% and 2% of all hand tumours are glomus tumours. The age at the time of diagnosis ranges from 30 years to 50 years. Men are less frequently affected than women.

The tumour is characterized by intense, often pulsating pain that may be spontaneous or provoked by the slightest trauma. Even changes in temperature, especially from warm to cold, may trigger pain radiating up to the shoulder. Sometimes the pain is worse at night: it may disappear when a tourniquet is applied.

The tumour is seen through the nail plate as a small, bluish to reddish-blue spot several millimetres in diameter, rarely exceeding 1 cm (Figure 5.25). Sometimes it causes a slight rise in surface temperature which can be detected by thermography. Minor nail deformities are caused by 50% of the tumours—ridging or a nail plate 'gutter' being the most common. A similar proportion cause a depression on the dorsal aspect of the distal phalangeal bone, or even a cyst visible on X-ray. Probing, which elicits pain, and transillumination may help to localize the tumour if it is not clearly visible through the nail. If the tumour cannot be localized clinically or by X-ray, arteriography should be performed; this will reveal a star-shaped telangiectatic zone. In selected cases, magnetic resonance imaging (MRI) has been shown to help in the diagnosis of a glomus tumour of the finger tip, revealing even very small lesions.

Many patients give a history of trauma. The most common misdiagnoses are neuroma, causalgia, gout and arthritis. Histological examination shows a highly differentiated, organoid tumour. It consists of an afferent arteriole, vascular channels lined with endothelium and surrounded by irregularly arranged cuboidal cells with round, dark nuclei and pale cytoplasm. Primary collecting veins drain into the cutaneous veins. Myelinated and non-myelinated nerves are found and may account for the pain. The tumour is surrounded by a fibrous capsule. Since all the elements of the normal glomus are present, the glomus tumour may be considered as a hamartoma rather than a true tumour.

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