The value of diagnostic ultrasonography in the assessment of a glomus tumor of the subcutaneous layer of the forearm mimicking a hemangioma: a case report

Abstract

IntroductionA glomus tumor is a rare, benign tumor with atypical clinical symptoms. Because of its small size, it is difficult to diagnose and treat early; therefore, it leads to poor quality of life. Glomus tumors are known to commonly affect the hand and rarely manifest in other areas. Because they simulate neuromas, hemangiomas, and neurofibromatosis, the differential diagnosis is difficult. We performed marginal resection of a solitary forearm mass previously suspected to be a hemangioma or glomus tumor on the basis of ultrasound findings and histologically diagnosed to be a glomus tumor afterward. We report this case to demonstrate the good prognosis of the procedure we used, and we review the relevant literature.Case presentationA 68-year-old Asian man without a particular medical history visited our hospital with a mass with focal tenderness in his left distal forearm that had developed 8 years earlier. The tumor was observed with suspicion of being a hemangioma or glomus tumor based on the location, clinical symptoms, and ultrasound findings taken into consideration together. The biopsy results led us to conclude that the lesion was a glomus tumor.ConclusionsA glomus tumor located in the forearm is very rare. It is often clinically overlooked and is likely to be misdiagnosed as another disease. The patient’s quality of life deteriorates, and, though the disease is rare, it has serious sequelae. Therefore, a quick diagnosis and appropriate treatment must be conducted early. If a mass occurs with serious pain in subcutaneous soft tissue of not the hands but the limbs, it is important to conduct examinations with suspicion of a glomus tumor. Ultrasonography performed quickly may be useful for making the differential diagnosis.

Color Doppler Sonography of Extradigital Glomus Tumors

“…Most of the cases reported in the literature exhibit Doppler findings similar to those detected in our series, although only a minority of imaging articles illustrate the color Doppler findings, 2,[4][5][6][7][8]18,20,23,25,28,[33][34][35] and only three of them 18,25,35 included the spectral Doppler findings. EDGTs are usually vascularized, although to a variable degree, and are not necessarily hypervascular.…”

“…Most of the published articles we found on the EDGT are single case reports . Additionally, only a minority of these articles include a description of the sonography findings . The three largest series published that included a description of the sonography findings collected 3, 4, and 9 18 cases of EDGT, respectively.…”

“…It is of note, however, that none of the 9 cases reported by Park et al showed intralesional calcifications. Differently from hemangioma, EDGT is firm and does not change in shape under probe‐mediated pressure . Werner et al reported a sensation of intralesional intermittent motion during the sonography examination, which could not be suppressed by compression.…”

“…[1][2][3][4]7,[10][11][12][13][14][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Additionally, only a minority of these articles include a description of the sonography findings. 2,4,12,13,20,[22][23][24][25]27,29,30,33,34 The three largest series published that included a description of the sonography findings collected 3, 6 4, 35 and 9 18 cases of EDGT, respectively. Glazebrook et al 23 reported the sonography findings in a patients with 4 EDGTs of the leg, 2 subcutaneous and 2 intramuscular, ranging in size from 7 to 52 mm.…”

“…Differently from hemangioma, EDGT is firm and does not change in shape under probe-mediated pressure. 23,25,34 Werner et al 33 reported a sensation of intralesional intermittent motion during the sonography examination, which could not be suppressed by compression. We did not record this aspect, but it is also our experience that EDGTs, particularly when large and hypervascular, may exhibit some kind of visual pulsatility.…”