Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 6222  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
E-IJD® - CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 4  |  Page : 480
Clinicopathological study of glomus tumors in a tertiary care hospital


From the Department of Pathology, Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chinnakolambakkam, Madhuranthagam, Tamil Nadu, India

Date of Web Publication2-Nov-2022

Correspondence Address:
Poornima Kumararaja
From the Department of Pathology, Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chinnakolambakkam, Madhuranthagam, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_564_21

Rights and Permissions



How to cite this article:
Kumararaja P, Sigamani K, Harke AB. Clinicopathological study of glomus tumors in a tertiary care hospital. Indian J Dermatol 2022;67:480

How to cite this URL:
Kumararaja P, Sigamani K, Harke AB. Clinicopathological study of glomus tumors in a tertiary care hospital. Indian J Dermatol [serial online] 2022 [cited 2022 Dec 10];67:480. Available from: https://www.e-ijd.org/text.asp?2022/67/4/480/360335





   Introduction Top


Glomus tumours are rare benign, mesenchymal soft tissue neoplasms of vascular origin constituting 1.6% of all soft tissue tumors.[1] They arise from modified smooth muscle cells present in the walls of specialized arterio-venous anastomoses (Sucquet-Hoyer canal) that are located in the subcutaneous tissue and are normally responsible for the regulation of temperature and blood pressure.[2] These tumors usually present as painful subcutaneous nodules in the subungual area of the digits and rarely involve extra-digital sites that are often misdiagnosed clinically.[3] In the present study, all the cases of digital and extra digital glomus tumours reported during the 5 year study period are analysed for all the salient clinical and pathological features.


   Materials and Methods Top


A retrospective study of all lesions diagnosed as glomus tumor in the histopathological evaluation during the period between October 2015 and November 2020 was carried out in a tertiary care hospital. Glomus tumours involving both the digital and extra-digital sites were included. The clinical parameters and histopathological features were analysed with review of literature. Immunohistochemistry was carried out for confirmation.


   Results Top


  • Total number of glomus tumors encountered in this study was six. Among them four tumors occurred in male with male: female ratio of 2:1 and the common age group affected was 20-40 years. [Table 1]
  • These tumors showed equal distribution in digital and extra-digital sites with two lesions located in the proximal interphalangeal joint of fingers, two lesions in the arm, one in the great toe and one in the post-auricular region. [Figure 1]
  • All the tumours presented clinically as reddish nodules associated with pain. Two of these lesions showed variation in the pain intensity relative to tactile stimulation (point tenderness) and temperature (cold sensitivity). [Table 2]
  • The size of these tumours varied from 0.5 cm to 5 cm in diameter. [Table 3]
  • Microscopically, all the six cases were of solid glomus tumour subtype with no glomangioma or glomangiomyoma reported in this study. They were well circumscribed tumor masses composed of monotonous population of round to ovoid cells with moderate eosinophilic cytoplasm and central round uniform nuclei arranged in sheets and nests separated by large number of thin walled compressed vessels and myxoid stroma. [Figure 2] and [Figure 3]
  • Immunohistochemistry was carried out to differentiate from other vascular lesions. Smooth Muscle Actin (SMA) showed diffuse strong cytoplasmic positivity in the tumor cells around the vessels while CD34 was negative in the tumor cells and it stained the normal endothelium alone. These features were consistent with that of Glomus tumor. [Figure 4] and [Figure 5]
  • All the six cases were treated by surgical excision following which they showed complete cure and were free of recurrences in the post-operative period.
Table 1: Age distribution

Click here to view
Table 2: Clinical Presentation

Click here to view
Table 3: Tumor size

Click here to view
Figure 1: Site distribution of Glomus tumors

Click here to view
Figure 2: H and E, 10×- Solid sheets of tumor cells around compressed vessels and myxoid stroma

Click here to view
Figure 3: H and E, 40×- Tumor cells are round to ovoid with eosinophilic cytoplasm and central round nuclei

Click here to view
Figure 4: IHC, 40×- Smooth Muscle Actin positivity in tumor cells

Click here to view
Figure 5: IHC, 40×- CD34 negative in tumor cells

Click here to view



   Discussion Top


Glomus tumor is known as a benign and vascular hamartoma containing all the neuromyoarterial cells of the normal glomus apparatus.[1] These glomus bodies are contractile tissue and they are primarily responsible for the local temperature and blood pressure modulation and they accomplish this by controlling blood flow through microvasculature.[4] The aetiology of glomus tumors is unknown and it may be related to sex, age, trauma or inheritance. BRAF mutations are seen in some tumors.[2] Most of these tumors occur in adults aged 20-40 years similar to the present study with no sex predilection.[2] In the present study, male predominance was noted.

The common presentation of the tumor is painful red blue or purple coloured, subcutaneous nodules with a hard consistency.[5],[6] Glomus tumours are mainly reported as small nodules which rarely exceed a diameter of 1 cm associated with paroxysmal pain in relation to tactile stimulation or temperature variation (cold sensitivity).[7] All these findings were in concurrence with the present study.

Glomus tumours mainly arise in the dermis or subcutaneous tissues of the hands and feet, especially the tips of fingers and toes. Extra-digital glomus tumours are rare; less than 1% of glomus tumours are found in the head region.[8],[9] In the present study, there was an equal incidence of glomus tumours in digital and extra-digital sites.

Histological study reveals a variable composition of glomus cells, blood vessels and smooth muscles. Based on the relative proportion of the three constituents, glomus tumours are categorised into three subtypes-Glomangiomas with an abundance of vessels; solid glomus tumour which is chiefly composed of glomus cells and Glomangiomyomas showing a predominance of smooth muscles.[10],[11] In the present study, all belonged to the subtype of solid glomus tumor. A typical solid glomus tumour is composed of small vascular channels surrounded by clusters of well-defined round cells with lightly eosinophilic cytoplasm and a large central round or oval nucleus with no atypia.[11],[12]

The immunohistochemical profile of glomus tumour cells includes positivity for vimentin, smooth muscle actin, and muscle-specific actin.[13] Some of the tumours showed positive results for desmin and CD34. Conversely, these tumours yield negative results for S-100, myoglobin, neurofilaments and factor VIII-related antigen.[14]

Complete surgical excision is the curative treatment of choice for glomus tumours. Incomplete excision is considered the main cause of recurrence.[14] Malignant transformation is uncommon and usually carries a benign course.[15]

Various clinical differential diagnoses include a neural tumor such as a neurofibroma, vascular tumor including haemangioma, angioma or haemangiopericytoma, plantar fasciitis, leiomyoma or metastasis.[11] Thus, glomus tumour should be considered in the differential diagnosis of any painful soft tissue mass.[15]


   Conclusion Top


Glomus tumours are rare tumours with a classic clinical presentation and typical symptoms of long-term pain and sensitivity to touch. The diagnosis of extra-digital glomus tumours remains a challenge for clinicians. Their unusual location and non-specific clinical findings, except for pain, make the diagnosis difficult. Therefore, proper history, clinical examination and high index of suspicion are essential for the correct clinical diagnosis, while histopathology confirms the diagnosis of glomus tumour. Inspite of its rare occurrence, glomus tumour should always be kept in mind for the differential diagnosis of all painful subcutaneous lesions especially for those with purple reflection on the skin surface so that proper treatment could be offered to the patient following proper diagnosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Friske JE, Sharma V, Kolpin SA, Webber NP. Extradigital glomus tumor: A rare etiology for wrist soft tissue mass. Radiol Case Rep 2016;11:195-200.  Back to cited text no. 1
    
2.
Fletcher CDM. Pathology and genetics of tumours of soft tissue and bone. Lyon: IARC Press; 2013.  Back to cited text no. 2
    
3.
Liapiavgeri G, Karabelabouropoulou V, Agnanti N. Glomus tumor. A histological, histochemical and immunohistochemical study of the various types. Pathol Res Pract 1994;190:2-10.  Back to cited text no. 3
    
4.
Weiss SW, Goldblum JR. Perivascular tumors. Enzinger and Weiss's Soft tissue tumors. 5th ed. Maryland Heights, MO: Mosby; 2007. p. 751-6.  Back to cited text no. 4
    
5.
Temiz G, Şirinoğlu H, Demirel H, Yeşiloğlu N, Sarıcı M, Filinte GT. Extradigital glomus tumor revisited: Painful subcutaneous nodules located in various parts of the body. Indian J Dermatol 2016;61:118.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Calonje E. Vascular Tumors: Tumors and Tumor-Like Conditions of Blood Vessels and Lymphatics-Lever's Histopathology of the Skin. 10th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2009. p. 1047-9.  Back to cited text no. 6
    
7.
Gombos Z, Zhang PJ. Glomus tumor. Archiv Pathol Lab Med 2008;132:1448-52.  Back to cited text no. 7
    
8.
Zou H, Song L, Jia M, Wang L, Sun Y. Glomus tumor in the floor of the mouth: A case report and review of the literature. World J Surg Oncol 2018;16:201.  Back to cited text no. 8
    
9.
Caughey DE, Highton TC. Glomus tumour of the knee. Report of a case. J Bone Joint Surg Br 1966;48:134-7.  Back to cited text no. 9
    
10.
Morey VM, Garg B, Kotwal PP. Glomus tumours of the hand: Review of literature. J Clin Orthop Trauma 2016;7:286-91.  Back to cited text no. 10
    
11.
Perks FJ, Beggs I, Lawson GM, Davie R. Juxtacortical glomus tumor of the distal femur adjacent to the popliteal fossa. Am J Roentgenol 2003;181:1590-92.  Back to cited text no. 11
    
12.
Chakrapani A, Warrick A, Nelson D, Beadling C, Corless CL. BRAF and KRAS mutations in sporadic glomus tumors. Am J Dermatopathol 2012;34:533-5.  Back to cited text no. 12
    
13.
Rallis G, Komis C, Mahera H. Glomus tumor: A rare location in the upper lip. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 2004;98:327-36.  Back to cited text no. 13
    
14.
El Jouari O, Gallouj S, Elloudi S, Senhaji G, Rimani M, Mernissi FZ. A painless glomus tumor: A case report. J Med Case Rep 2018;12:302.  Back to cited text no. 14
    
15.
Amillo S, Arriola FJ, Munoz G. Extradigital glomus tumour causing thigh pain. Bone Joint J 1997;79:104-6.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (1,295 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed254    
    Printed8    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal