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Introduction Glomus tumors (GT) are rare, benign tumors that arise from glomus bodies and usually develop in digital areas. Extradigital GT are exceptional and thigh location is infrequent. Case Report We report a case of a GT of the thigh in a 79‐year‐old male patient that measured 9.5 cm in maximum size. The GT lay above the muscular fascia without infiltrating it. Internal hypervascularity was seen by spectral Doppler ultrasound. Magnetic resonance image showed a heterogeneous mass with hyperintense and hypointense components and internal lobes with liquid–liquid levels. Histopathology revealed a monotonous round‐cell proliferation with central nuclei without atypia or mitotic figures, around small‐caliber vessels. These cells expressed smooth muscle actin and pericellular collagen IV. GT of uncertain malignant potential was diagnosed. The mass was completely removed. The patient did not experience local relapse nor distant metastasis. Conclusion GT are rare soft tissue tumors whose diagnosis of unusual giant masses in uncommon locations may be delayed and misdiagnosed given the low suspicion.

BackgroundInflammatory back pain (IBP) is the core symptom in patients with axial spondyloarthritis (axSpA). For its assessment, experts recommend using the Assessment of SpondyloArthritis International Society (ASAS) criteria. Advances in telemedicine and online screening strategies require to evaluate whether self-reported perform equally to physicians’ assessment.ObjectivesTo assess the agreement and correlation between self-reported and physician´s assessments of ASAS IBP criteria and evaluate their performance compared with rheumatologist´s judgement for IBP.MethodsThe “Strategy for a Hospital Early Referral in Patients with Axial Spondyloarthritis” (SHERPAS) is a prospective ongoing study recruiting young patients (18 to 40 years) with chronic back pain asked to undergo an MRI of the spine by other specialists different than rheumatologists in a tertiary hospital, starting in September 2021. After inclusion, an additional MRI of the sacroiliac joints (SIJ), followed by a rheumatology visit and eligible blood tests were performed. IBP was assessed in 3 different independent ways: i) ASAS criteria asked verbatim by the rheumatologist (ASAS-IBP-phy criteria), ii) ASAS criteria embedded in a self-reported questionnaire (ASAS-IBP-self reported), and iii) according to rheumatologist judgement in the interview (IBP-rheumatologist). Dataset for this interim analysis was locked in October 2022. Kappa statistic (κ) and tetrachoric correlation coefficient (rt) were calculated to assess the agreement and correlation between ASAS-IBP-phy criteria and ASAS-IBP-self reported. Overall accuracy, sensitivity, specificity, positive and negative predictive values for each IBP assessment method were calculated, using IBP-rheumatologist as gold standard.ResultsAmong 152 recruited patients, 85 (55.9%) were female; mean (SD) age was 34.2 (5.3) years. 66/152 (43.4%) patients reported IBP by at least one of the three assessments, and 24 (15.8%) patients presented back pain as assessed by the three methods altogether. Venn diagrams representing the overlap between the different IBP assessments are shown inFigure 1. A moderate agreement (κ =0.48) and strong correlation (rt=0.7) were found between ASAS-IBP-self reported and ASAS-IBP-phy criteria. While ASAS-IBP-phy criteria showed a strong level of agreement and very strong correlation with IBP- rheumatologist (κ = 0.74, rt= 0.94), ASAS-IBP-self reported showed a moderate agreement and moderate correlation with this outcome (κ = 0.44, rt=0.67). ASAS-IBP-phy criteria showed better performance than ASAS-IBP-self reported for capturing IBP- rheumatologist [accuracy of 0.89 (95%CI 0.83- 0.94) vs 0.77 (95%CI 0.70- 0.84)](Table 1).ConclusionASAS criteria to define IBP show higher level of agreement and correlation with IBP rheumatologist overall judgement when assessed by physician as compared to a self-reported assessment. These results call for caution when extrapolating use of experts IBP criteria from clinical to online setting and suggest that clinicians should prioritize physician assessment over self-report to define this.Figure 1.Number of patients showing IBP by each method of assessmentTable 1.Utility measures for each IBP assessment method to capture IBP according to rheumatologist judgementASAS-IBP-phy criteriaASAS-IBP-self reportedAccuracy0.890.78Sensitivity0.890.81Specificity0.920.66Negative Predictive Value0.730.54Positive Predictive Value0.970.87AcknowledgementsThe SHERPAS study has been conducted thanks to an unrestricted grants from Novartis.Disclosure of InterestsDiego Benavent Speakers bureau: Abbvie, Janssen, and Galapagos., Grant/research support from: Novartis, Mar Tapia-Viñé: None declared, Daniel Bernabeu: None declared, Victor Muley: None declared, Chamaida Plasencia Speakers bureau: from Pfizer, Abbvie, Lilly, Sandoz, Sanofi, Biogen, Roche, Novartis, Grant/research support from: Pfizer and Abbvie, Alejandro Balsa Speakers bureau: from Pfizer, Abbvie, Lilly, Galapagos, BMS, Sandoz, Nordic Pharma, Gebro, Roche, Sanofi, UCB, Consultant of: Pfizer, Abbvie, Lilly, Galapagos, BMS, Nordic Pharma, Sanofi, UCB, Grant/research support from: Pfizer, Abbvie, BMS, Nordic Pharma, Gebro, Roche, UCB, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie and Novartis.

Introduction Intranodal palisaded myofibroblastoma (IPM) is an exceedingly rare benign mesenchymal tumor of the lymph nodes. Magnetic resonance imaging (MRI) findings are unspecific, which may present diagnostic challenges to fine‐needle aspiration cytology (FNAC). The histological and immunohistochemical features of IPM are unique. Case Report A previously healthy 40‐year‐old male patient presented a slow‐growing solitary left inguinal mass. FNAC revealed clustered cells within a metachromatic stroma, single spindle cells without atypia, hemosiderin pigment, and siderophages. An MRI showed a central hyperintense septum in fat‐suppressed, T2‐weighted sequences. The excised lymph node contained central haphazard fascicles of spindle cells with focal nuclear palisading, hemosiderin pigment, extravasated erythrocytes, and hemorrhagic areas. Vimentin and smooth muscle actin were diffusely positive. Amianthoid collagen fibers were not clearly observed. Conclusion IPM is an extremely rare mesenchymal benign intranodal tumor that should be included in the differential diagnosis of spindle cell lesions in the inguinal region.

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