Core Dermatology Diagnoses / CategoriesNeoplastic Benign and Malignant

Glomus tumor

Author: Faculty Reviewer:

Publish date: Posted on
Last updated: February 16, 2022

Keywords #

glomus tumor
soft tissue neoplasm
vascular tumors

Diagnosis #

First described as “painful subcutaneous tubercles,” glomus tumors are neuromyoarterial neoplasms that originate from the glomus bodies. The latter are highly concentrated in the fingertips, thus glomus tumors are most common in the hands and subungual region.[1]  Glomus bodies play a role in thermoregulation, blood pressure control, and cutaneous blood flow.[2] Hyperplasia of any part of the glomus body including the primary collecting vein, afferent arteriole, or intraglomerular reticulum can lead to tumor formation.[2]

Key Concepts #
  • Hyperplasia of any part of the glomus body can lead to glomus tumor formation. 
  • The clinical triad of cold hypersensitivity, severe pain, and pinpoint tenderness are suggestive of glomus tumors. 
  • The most common location of these tumors is the subungual region of the distal phalanx of the fingers. 
  • Biopsy and histopathology are diagnostic but imaging is important in determining tumor size and depth. 
  • The treatment of choice for symptomatic lesions is surgical excision for immediate pain relief. 
Epidemiology #

Glomus tumors occur more often in women than men and account for 1%-5% of soft-tissue hand tumors.

Clinical Features #
  • Although the subungual region of the distal phalanx of the fingers is the most common location, they may appear on the limbs, palm, wrist, and feet.[2]  
  • They present as multiple or solitary small, slightly raised, blue or pink nodules.[1]  
  • Nail changes including elevation, deformity, and discoloration may result from subungual tumors.[2]  
  • A triad of cold hypersensitivity, severe pain, and pinpoint tenderness are suggestive of glomus tumors.[1]  
  • Placing an ice cube on the nail or submerging the digit in cold water can exacerbate the pain.  
  • Dermoscopic features include a whitish external fibrous capsule with a central purple hue from enlarging vessels.[1] 
Differential Diagnoses #
  • Neuroma 
  • Schwannoma 
  • Hemangioma 
  • Angiolipoma 
  • Blue rubber bleb nevus syndrome 
  • Dercum disease 
  • Leiomyoma 
  • Granular cell tumor 
Diagnostic Workup #

Glomus tumors can be diagnosed with histopathology, but preoperative imaging is important in determining tumor size and depth. MRI or ultrasound are commonly used, ultrasound renders glomus tumors as well-circumscribed hypoechoic masses.[3] 

Histopathology features include aggregates of small, round, monomorphic cells making up well-circumscribed dermal nodules.[4] Tumor cells have hyperchromatic nuclei, eosinophilic cytoplasm, and hyalinized stroma cell border.[4] 

 

Treatment #

The treatment of choice for symptomatic lesions is surgical excision which also provides immediate pain relief.[1]

References #
  1. Idoudi S, Arousse A, Boussofara L. Glomus Tumor of the Buttock. Dermatology Practical & Conceptual. 2019:318-319.
  2. Morey VM, Garg B, Kotwal PP. Glomus tumours of the hand: Review of literature. Journal of Clinical Orthopaedics and Trauma. 2016;7(4):286-291.
  3. Shinohara T, Hirata H. Glomus Tumor Originating from a Digital Nerve. Plastic and Reconstructive Surgery – Global Open. 2019;7(6).
  4. Marcella C, Shi R, Yu T, Sarwar S, Wang X, Liu Y. Asymptomatic esophageal glomus tumor: case report. Journal of Gastrointestinal Oncology. 2019;10(5):1015-1020. 
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