Glomus Extradigital Tumor: A Case Report of an Extradigital Glomus Tumor on the Wrist and Comprehensive Review of Glomus Tumors

Abstract

A glomus tumor is a neoplasm composed of cells from the glomus body which is a contractile neuromyoarterial structure that affects blood pressure and thermoregulation by altering cutaneous blood flow. This cutaneous tumor can be benign or rarely malignant, solitary or multiple, and digital or extradigital. A benign glomus tumor usually presents as a non-familial, solitary, and subungual lesion. Multiple glomus tumors are less common, may be autosomal dominantly inherited, and extradigital. In contrast to a digital glomus tumor that often occurs within the nailbed or fingertip pulp of a young woman, a glomus extradigital tumor (GET) typically appears on the extremity or trunk of an older man. The diagnosis of a glomus tumor may be suspected based on clinical evaluation; it classically presents with a clinical triad of symptoms which includes lesion-associated tenderness, pin-point pressure pain, and cold sensitivity. However, cold-induced exacerbation of pain is frequently absent in extradigital glomus tumors; this may contribute to a delay in establishing the diagnosis of a glomus tumor in these individuals. Radiographic studies can support the diagnosis, but tissue specimen examination is necessary to establish the diagnosis. Resolution of tumor-associated pain is usually achieved following the complete excision of the neoplasm. A woman with a glomus tumor located on her wrist is described; her painful tumor was not sensitive to cold and was misdiagnosed clinically as a possible foreign body reaction to either a wood splinter or glass shard. The diagnosis of an extradigital glomus tumor was established after a microscopic examination of the tissue specimen following an excisional biopsy using a 3-millimeter punch biopsy tool. The neoplasm-related pain ceased and did not recur after the tumor had been completely removed. In conclusion, a glomus tumor is included in the differential diagnosis of a painful cutaneous neoplasm; however, misdiagnosis and/or substantial delay in diagnosis may occur if the tumor is extradigital or it lacks cold sensitivity or both. Therefore, the clinician needs to entertain the possibility of an extradigital glomus tumor when evaluating a patient with a tender, temperature-insensitive skin lesion that is not located on the fingers or toes.

Benign Tumors of the Wrist, Hand, and Fingers

“…Radiographic imaging may reveal a softtissue radiolucency and may exhibit smooth scalloping of adjacent bone. MRI demonstrates similar characteristics to normal occurring subcutaneous fat revealing well-demarcated margins with a fibrous pseudocapsule 1,3,4,[8][9][10] . Conversely, low-grade lipomatous neoplasms do not enhance with contrast, and the fibrous pseudocapsule may only be mildly enhanced 3,6 .…”

“…5) 8 . While composed primarily of fatty tissue, lipomas evolve from mesenchymal preadipocytes 8,9 . Lipomas present as slowly enlarging, nontender, mobile, painless, doughy soft-tissue masses 1,3,[8][9][10] .…”

“…While composed primarily of fatty tissue, lipomas evolve from mesenchymal preadipocytes 8,9 . Lipomas present as slowly enlarging, nontender, mobile, painless, doughy soft-tissue masses 1,3,[8][9][10] . However, subfascial lipomas are much less mobile than subcutaneous lipomas and can present with more pain resulting from space restrictions associated with the subfascial region 6 .…”

“…Adipose tumors adjacent to a peripheral nerve contribute to compression neuropathy 3,4,6 . This is more frequently seen in the carpal tunnel (median nerve), Guyon's canal (ulnar nerve), and the interdigital space (common digital nerve) [1][2][3][4][8][9][10] . Digital lipomas are rare compared with those lipomas occurring in the hand and wrist 3,10 .…”

“…Functional impairment, cosmetic dissatisfaction, size (.5 cm), and fast-growing painful lesions will affect treatment decisions. In most cases, excision of the lipoma mass has a high success rate and low recurrence 1,3,4,6,[8][9][10] .…”