| Glomus tumor | |
|---|---|
| Classification and external resources | |
Micrograph of a glomus tumor. H&E stain. |
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| ICD-10 | D18 (ILDS D18.011) |
| ICD-O: | 8711/0 |
| OMIM | 138000 |
| DiseasesDB | 30732 |
| eMedicine | derm/167 |
| MeSH | D005918 |
A glomus tumor (also known as a "solitary glomus tumor,"[1] "solid glomus tumor,"[1] glomangioma, and nonchromaffin paraganglioma[2]) is a rare benign neoplasm arising from the glomus body.[3]:670 Glomus tumors were first described by Hoyer in 1877, while the first complete clinical description was given by Masson in 1924.[4]
Familial glomangiomas have been associated with a variety of deletions in the glomulin gene, and are inherited in an autosomal dominant manner, with incomplete penetrance.[4]
They are usually solitary and small, and can be found under the fingernails.[5] They can also be found on the tympanic membrane.[6]
They are often painful, and the pain is reproduced when the lesion is placed in cold water.
These tumors tend to have a bluish discoloration, although a white appearance is also noted. Elevation of the nail bed can occur
In rare cases, the tumors may present in other body areas, such as the gastric antrum or glans penis. Treatment is essentially the same. [7]
The exact incidence of glomus tumors is unknown. The multiple variant is rare, accounting for less than 10% of all cases. The probable misdiagnosis of many of these lesions as hemangiomas or venous malformations also makes an accurate assessment of incidence difficult.
The most common adverse effect is pain, which is usually associated with solitary lesions. Multiple tumors are less likely to be painful. In one report, a patient with more than 400 glomus tumors had thrombocytopenia as a result of platelet sequestration (ie, Kasabach-Merritt syndrome). Malignant glomus tumors, or glomangiosarcomas, are extremely rare and usually represent a locally infiltrative malignancy. However, metastases do occur and are usually fatal.
Solitary glomus tumors, particularly subungual lesions, are more common in females than in males. Multiple lesions are slightly more common in males.
Solitary glomus tumors are more frequent in adults than in others. Multiple glomus tumors develop 10–15 years earlier than single lesions; about one third of the cases of multiple tumors occur in those younger than 20 years. Congenital glomus tumors are rare; they are plaquelike in appearance and are considered a variant of multiple glomus tumors.
Malignant glomus tumors, histologically and/or clinically are exceedingly rare. Criteria for the diagnosis of malignancy in glomus tumors are:[8]
Malignant glomus tumors have been subdivided into three categories based on their histologic appearance: locally infiltrative glomus tumors (LIGT), glomangiosarcomas arising in benign glomus tumors (GABG), and glomangiosarcomas arising de novo (GADN). [9]
A few cases of malignant glomus tumors have been reported; however, they are usually only locally invasive, and metastases are exceedingly rare. Brathwaite et al in 1996 reported widespread metastases of a malignant glomus tumor involving the skin, lungs, jejunum, liver, spleen, and lymph nodes.[10] Another report of a malignant glomus tumor with metastases is that of Watanabe et al., who reported a cutaneous malignant glomus tumor with widespread metastases.[11] A few other cases of malignant glomus tumors have been reported in the literature usually occur in the older age group, and have been described at several locations, primarily the soft tissues and gastrointestinal tracts.
Recently, Lamba G et al reported the first case of malignant glomus tumor arising from the kidneys. [12]
Radiation therapy and surgery can be involved in the treatment of these tumors.[13]
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