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CASE REPORT
Year : 2010  |  Volume : 55  |  Issue : 4  |  Page : 397-398
Extra digital glomangioma


Department(s) and institution(s) Dermatology, Gandhi Medical College/Gandhi Hospital, Hyderabad, India

Date of Web Publication4-Jan-2011

Correspondence Address:
A Gnaneshwar Rao
F- 12, B-8, HIG-2 APHB, Baghlingampally, Hyderabad
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.74570

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   Abstract 

Glomus tumors are relatively rare vascular tumors with reported incidence of 1.6% of all soft tissue tumors. It is variously regarded as a hamartoma or a neoplasm of neuromyoarterial glomus, which consists of dilated vascular channels, surrounded by proliferating glomus, nerve cells, and plays an important role in temperature regulation. We report the case of glomangioma in a 43-year-old male who came to dermatology OPD with a painful lesion over the right elbow of six months duration. Cutaneous examination revealed a single round reddish blue papule of about 0.5 cm in size on the flexor aspect of the right elbow. The papule was firm in consistency and tender. The excision biopsy showed stratified squamous lining with well circumscribed tumor in the dermis. The tumor consisted of sheets of uniform cells with pale cytoplasm; round to ovoid centrally placed punched out nuclei and well defined cell margins. There were numerous dilated thin walled vascular spaces surrounded by a layer of tumor cells and the histopathology was consistent with glomangioma.


Keywords: Glomangioma, glomus tumor, soft tissue tumor, reddish blue papule


How to cite this article:
Rao A G, Indira D, Kamal J. Extra digital glomangioma. Indian J Dermatol 2010;55:397-8

How to cite this URL:
Rao A G, Indira D, Kamal J. Extra digital glomangioma. Indian J Dermatol [serial online] 2010 [cited 2019 Aug 21];55:397-8. Available from: http://www.e-ijd.org/text.asp?2010/55/4/397/74570



   Introduction Top


Glomus tumours are relatively rare vascular tumours with reported incidence of 1.6% of all soft tissue tumours. [1] It is variously regarded as a hamartoma or a neoplasm of neuromyoarterial glomus, which consists of dilated vascular channels surrounded by proliferating glomus and nerve cells (Suckquet-Hoyer canal) and plays an important role in temperature regulation. Solitary glomus tumours are usually seen in adults equally commonly in both sexes except for subungual glomus tumours which show a female preponderance. [2] A soliltary glomus tumour is a pink or purple nodule with classic triad of pain, cold sensitivity and point tenderness. [3] The commonest site is the hands, particularly the fingers. Here we report a case of Glomus tumour involving unsual site.


   Case Report Top


A 43-year-old male came to dermatology OPD with a painful lesion over the right elbow of six months duration. The lesion started as a small papule gradually increased to the present size of 0.5 cm. There was no history of trauma preceding the swelling. Cutaneous examination revealed a single round reddish blue papule of about 0.5 cm in size on the flexor aspect of the right elbow [Figure 1].The papule was firm in consistency and tender. The excision biopsy showed stratified squamous lining with well circumscribed tumor in the dermis [Figure 2]. The tumor consisted of sheets of uniform cells with pale cytoplasm; round to ovoid centrally placed punched out nuclei and well defined cell margins. There were numerous dilated thin walled vascular spaces surrounded by a layer of tumor cells [Figure 3] consistent with the diagnosis of glomangioma.
Figure 1 :Reddish blue papule over flexor aspect of right elbow

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Figure 2 :HPE H&E stain ×10 showingstratified squamous lining with well circumscribed tumour in the dermis

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Figure 3 :HPE H&E stain X40 showing the tumour consisting of sheets of uniform cells with pale cytoplasm; round to ovoid centrally placed punched out nuclei and well defined cell margins. There are numerous dilated thin walled vascular spaces surrounded by a layer of tumour cells

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   Discussion Top


Glomus tumors are relatively rare vascular tumors with reported incidence of 1.6% of all soft tissue tumors. [1] It is variously regarded as a hamartoma or a neoplasm of neuromyoarterial glomus, which consists of dilated vascular channels, surrounded by proliferating glomus and nerve cells (Sucquet-Hoyer canal) and plays an important role in temperature regulation. Solitary glomus tumors are usually seen in adults equally commonly in both sexes except for subungual glomus tumors which show a female preponderance. [2] A soliltary glomus tumor is a pink or purple nodule with classic triad of pain, cold sensitivity and point tenderness. [3] The commonest site is the hand, particularly the fingers. There have been reports in the literature of unusual location of glomus tumor such as ankle, [4] foot, [5] knee, [6] thigh [7] and hip. [8] Glomus tumors may be solitary or multiple; the latter may be further divided into regional or disseminated, which are usually familial or congenital. Other variants such as plaque type and patch type have been described.

Histologically, the tumors have variable quantities of glomus cells, blood vessels and smooth muscles. [9] Accordingly, they are classified as solid glomus tumors (25%), glomangioma (60%) and glomangiomyoma (15%). Solid glomus tumors are composed of aggregates of glomus cells surrounding inconspicuous vessels. Glomus cells are round, regular with pale or eosinophilic cytoplasm and dark staining round to oval nuclei. Glomangiomas have more prominent vessels and less conspicuous glomus cells.

In glomangiomyoma there is an increase in number of spindle shaped smooth muscle cells which tend to be distributed near the vascular spaces and blend with adjacent glomus cells. the histological features in our case were that of a glomangioma. Glomangioma has to be differentiated from the painful tumors of the skin such as eccrine spiradenoma, where two populations of cells and focal ductal differentiation are seen from leiomyoma and neuromatoid hyperplasia. Multiple hemangiomas has to be differentiated from blue rubber naevus.

The treatment of choice for isolated glomangioma is surgical excision. Sclerotherapy with sodium tetra decyl sulphate, polidocinol and hypertonic saline has been reported to be effective in patients with multiple glomangioma located on the extremities. However, sclerotherapy was found to be ineffective in a series of seven patients with large glomangioma. Ablative therapy with Argon and Carbondioxide laser is of potential benefit for small superficial lesions.

 
   References Top

1.Shugart RR, Soule EH, Johnson EW Jr. Glomus Tumor. Surg Gynecol Obstet 1963;117:334-40.  Back to cited text no. 1
    
2.Shivaswamy KN, Thappa DM, Jayanthi S. A solitary painful nodule. Indian J Dermatol Venereol Leprol 2003;69:359-60.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Walsh JJ 4th, Eady JL. Vascular tumors. Hand Clin 2004;20:261-8.  Back to cited text no. 3
    
4.Smyth M. Glomus-cell tumors in the lower extremity. Report of two cases. J Bone Joint Surg Am 1971;53:157-9.  Back to cited text no. 4
    
5.Quigley JT. A glomus tumor of the heel pad. A case report. J Bone Joint Surg Am 1979;61:443-4.  Back to cited text no. 5
    
6.Caughey DE, Highton TC. Glomus tumor of the knee. Report of a case. J Bone Joint Surg Br 1966;48:134-7.  Back to cited text no. 6
    
7.Negri G, Schulte M, Mohr W. Glomus tumor with diffuse infiltration of the quadriceps muscle: a case report. Hum Pathol 1997;28:750-2.  Back to cited text no. 7
    
8.Gencosmanoglu R, Inceoglu R, Kurtkaya-Yapicier O. Glomangioma of the hip. Dermatol Surg 2003;29:1244-7.  Back to cited text no. 8
    
9.Weedon D. Vascular tumours. In Weedon D, Editor Skin Pathology. 2nd ed London: Churchill-Livingston; 2002. p.1016-7.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]

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