glomus tumours

Last reviewed 01/2018

These are benign tumours of modified smooth muscle cells which arise from the glomera

• glomus tumour is a rare benign neoplasm that arises from the neuroarterial structure called a glomus body, which accounts for 1 % to 4.5 % of tumours in the hand (1,2)
  • clinical features include blue discoloration, palpable nodule, and nail deformity in subungual tumors. The Hildreth's test and the Love's pin test are reliable methods of diagnosing glomus hand tumors with sensitivity and specificity exceeding 90% (3)
    
    
• glomus tumours occur as some tissues of a glomus body proliferate
  • a glomus body
    • a specialized arteriovenous anastomosis responsible for thermoregulation and is located in the reticular layer of the dermis
  • glomus tumours arise from deformed smooth muscle cells called glomus cells, which constitute a normal glomus body and are located in the walls of the Sucquet-Hoyer canal - these cells are present throughout the entire body
  • glomus tumours mostly develop in the skin
    • but are also reported to arise in the mucous membrane or internal organs such as the stomach, lung, trachea, and bone
  • most common site for glomus tumors is the hand-particularly the subungual area, the lateral aspect of the digits, and the palms
    

Glomus bodies and their tumours may occur anywhere in the skin, but are most common in the distal phalanges, especially beneath the nail beds. They are typically minute, often less than 1 cm in diameter

• patient with glomus tumor seeks medical attention early, but the mass is frequently too small to be identified on physical examination
  • although the classic triad of moderate pain, temperature sensitivity, and point tenderness has been described, these are nonspecific and not all may be present
  • mass is usually less than 1 cm in diameter, and therefore difficult to palpate
  • glomus tumours may also be found in the temporal bone
  • Click here for an example image of this condition

• investigation
  • Xrays are typically normal but in longstanding lesions erosions may be seen
  • ultrasound and MRI may be used in the diagnostic process
    
    
• management
  • complete surgical excision is the best method to treat symptoms and prevent recurrence

Notes:

• clinical diagnostic tests including Love's pin test, Hildreth's test, and a cold-sensitivity test can be helpful
  
  
  • Love's pin test
    • positive Love's pin test means patient experience severe pain and reduction in pain when the skin overlying the tumor is pressed with a pinhead, ballpoint pen, end of a paperclip, or Kirschner wire
      
      
  • Hildreth's test
    • performed by elevating the patients' arm to exsanguinate it
      • a tourniquet is inflated to 250 mm Hg and the tumor is palpated, the pain and tenderness should be reduced.
      • a test is positive when releasing the cuff causes a sudden onset of pain and tenderness in the area of the tumor
        
        
  • cold-sensitivity test is positive when immersing the hand in cold water elicits severe pain in and around the lesion

Reference:

• Carroll RE, Berman AT. Glomus tumors of the hand. J Bone Joint Surg. 1972;54A(4):691-703.
• Rettig AC, Strickland JW. Glomus tumor of the digits. J Hand Surg Am. 1977;2:261-265
• Hazani R, Houle JM, Kasdan ML, et al. Glomus tumors of the hand. Eplasty. 2008;8:e48.