Explaining Glomus Tumor Of The Hand

2009-07-17 13:14
Glomus Tumor of Hand

A glomus tumor is a rare benign tumor of the hand. Only 1-5% of the soft-tissue tumors in the hand are glomus tumors. It arises from the glomus body which is a neuromyoarterial apparatus described by P. Masson in 1924.

The normal glomus body is an arteriovenous (AV) shunt that is composed of an afferent arteriole, an anastomotic vessel (Sucquet-Hoyer canal), a collecting vein, and a capsular portion. It resides in the stratum reticulum of the skin. There are large numbers in the area below the fingernail (subungual region) and in the distal pad of the digits. The glomus body is a controlled AV anastomosis or shunt between the terminal vessels thought to be important in regulating peripheral blood flow in the digits, which secondarily controls peripheral blood pressure and body temperature.

Glomus tumors affect women two to three times more often than men. Most are in the 30-50 year age group. Most occur in the subungual area (approximately 50%), but can occur on the finger tip pulp, the palm, wrist, forearm and foot.

Symptoms usually consist of a triad

> severe paroxysmal pain--the pain can be excruciating and is described as a burning or bursting

> localized tenderness

> extreme cold sensitivity

Physical exam will often reveal a blue-pink tender mass that can often be seen through the nail plate or skin. When the mass is growing beneath the nailbed (subungual), it can displace the nailbed dorsally. This can create a longitudinal ridging of the fingernail.

The tumor consist of a highly organized, well-encapsulated mass consisting of glomus cells, curled blood vessels, and a large number of nerves within or adjacent to the lesion. This explains the great sensitivity of the glomus tumor.

Treatment is surgical. Surgical approach will vary depending on the location of the tumor. The glomus tumor is always well encapsulated and can usually be "shelled out" with little or no difficulty. When excision is complete, the prognosis is excellent for full recovery with no recurrence.

References
Glomus Tumor by Henry DeGroot, III MD--bonetumor.org

Glomus Tumor at Wheeless Textbook of Orthopedics

Subungual glomus tumor by Dr. K.-- MSKcases

Glomus Tumor of the Finger Tip and MRI Appearance by David H Kim, MD--Iowa Orthop J. 1999; 19: 136–138.

Two cases of subungual glomus tumor; Murthy PS, Rajagopal R, Kar PK, Grover S; Indian J Dermatol Venereol Leprol 2006;72:47-9

Glomus Tumor by Michael B Reynolds, MD--eMedicine Article

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