Glomus tumor imaging: Use of MRI for localization of occult lesions

doi:10.1016/0363-5023(92)90353-Q

The Journal of Hand Surgery

Volume 17, Issue 3, May 1992, Pages 472-475

https://doi.org/10.1016/0363-5023(92)90353-Q Get rights and content

Abstract

Magnetic resonance imaging has been performed in six patients with glomus tumors of the hand and correlated with clinical surgical histopathologic findings and with angiography in one case. Two of the patients had obscure pain without the classic clinical and radiologic findings of glomus tumors. The MRI examinations depicted the tumors in excellent detail and facilitated diagnosis in the two patients with atypical presentation. In all six cases the diagnoses were confirmed at surgery. The MRI proved valuable as a noninvasive and accurate means for the early diagnosis of occult glomus tumors.

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Cited by (79)

Atypically localized glomus tumor causing anterior interosseous nerve syndrome: A case report
2017, Acta Orthopaedica et Traumatologica Turcica
Citation Excerpt :
T1-weighted MR images show glomus tumors as dark, well-delineated lesions with low signal intensity and T2-weighted images show them as bright lesions with high signal intensity. Glomus tumors as small as 5 mm in the fingertip has been successfully shown with MRI.15 On the other hand, MRI can also help for identifying AINS.
This article presents a 48-year-old male patient who presented with pain in the left forearm and weakness and clumsiness in the left hand of 6 months' duration. Flexor motor strength loss of the thumb and the index finger was present and neurophysiologic tests showed findings compatible with axonal injury in the anterior interosseous nerve (AIN) innervated muscles. Magnetic resonance imaging revealed a space-occupying lesion in the proximal forearm resembling a glomus tumor. Excision of the mass and release of the AIN were performed. Histopathology confirmed a glomus tumor, and the patient remains asymptomatic at 1 year postoperatively. We stress the importance of imaging studies in patients when a suspected secondary nature of nerve entrapment is present.
An extremely rare case of a glomus tumor in the popliteal fossa
2016, Journal of Orthopaedics
Glomus tumors are the benign perivascular tumors that typically present with hypersensitivity to cold, paroxysmal severe pain, and pinpoint tenderness. This tumor is usually subungual lesions and accounts for 1.6% of all soft-tissue tumors. However, extradigital glomus tumors are extremely rare and can be difficult to diagnose, as they typically have a diameter of less than about 1 cm. We report a glomus tumor in the popliteal fossa of a 17-year-old male patient who experienced severe posterior knee pain while playing sports. A physical examination did not reveal a mass, although a glomus tumor was identified in the popliteal fossa using magnetic resonance imaging. We successfully performed open excision to remove the tumor, and the patient achieved a restored postoperative gait and could perform sports activities with no pain. These tumors are extremely rare in the knee area, and typically have a diameter of less than about 1 cm, which can complicate their diagnosis and treatment, despite the presence of severe pain. Therefore, we recommend that clinicians be aware of extradigital glomus tumors, as careful imaging can facilitate an early diagnosis and treatment.
Ultrasound of wrist and hand masses
2015, Diagnostic and Interventional Imaging
Citation Excerpt :
It accounts for 1.2% of hand tumors and 65% of tumors in the subungual region and generally affects patients between 20 and 40 years old, with a female predominance. Clinically, the lesion presents as a superficial red-blue nodule, which is usually painful, particularly with changes in temperature or pressure [12–14]. On ultrasound it mostly presents as a small, rounded lesion located beneath the nail bed, with a generally hypoechogenic structure, occasionally almost identical or slightly more echogenic than the nail bed.
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To determine whether the diagnosis of hand glomus tumors by magnetic resonance imaging (MRI) is associated with tumor size, tumor pathology, tumor location, and/or clinical suspicion.
We reviewed our pathology database for patients with hand glomus tumors diagnosed between 2006 and 2013 and included those patients who had preoperative MRI at our institution. We excluded patients with recurrent and persistent tumors. Magnetic resonance imaging reports were reviewed for clinical history, tumor location, and associated bone erosion. Pathology reports were reviewed for diagnosis and tumor size. We classified MRI studies as positive (glomus tumor diagnosis), negative (no mention of glomus tumor as possible diagnosis), or indeterminate (glomus tumor mentioned as possible differential diagnosis). Fisher exact test was used to compare positive studies and those that were nondiagnostic (ie, either negative or indeterminate).
Of the 46 patients who had pathologically confirmed hand glomus tumors, 38 had preoperative MRI studies. A total of 24 MRI studies were positive, 5 were indeterminate, and 7 were negative. Five patients had atypical pathology, 1 had a multifocal tumor, and 2 had extra-digital hand glomus tumors. Failure to diagnose glomus tumors on MRI was associated with atypical pathology, atypical location (ie, not located in the subungual region), absence of bone erosion, and lack of clinical suspicion. Tumor size was not associated with MRI diagnosis.
In this series of 36 hand glomus tumors, one-third of MRI studies were nondiagnostic. Occurrence of nondiagnostic MRIs was more likely when glomus tumors were pathologically and/or anatomically atypical, without bone erosion, and with no or unrelated clinical history provided. These findings highlight the continued importance of clinical suspicion in glomus tumor diagnosis.
Diagnostic IV.
Subungual glomus tumor
2012, Journal of Hand Surgery
Citation Excerpt :
Typical MRI angiographic findings are areas of strong enhancement during the arterial phase and tumor blush that increases in size in the delayed phase.13,16 Others have stated that MRI should be used for detection of multiple tumors.18–20 Although recurrences and metachronous multiple lesions can occur and multiple simultaneous glomus tumors are common, it might be hard to justify routine MRI use on this account alone for every case.8
Outcomes Following Excision of Toe Glomus Tumors
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^☆: Presented at the forty-fifth annual meeting of the American Society for Surgery of the Hand, Sept. 24, 1990, in Toronto, Ontario, Canada.

^☆☆: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Original communicationGlomus tumor imaging: Use of MRI for localization of occult lesions☆,☆☆

Abstract

J Hand Surg

Hand

Hand

J Hand Surg

J Hand Surg

J Hand Surg

Hand

J Hand Surg

Glomus tumors of the hand: review of the literature and report on twenty-eight cases

J Bone Joint Surg

High-field MR surface-coil imaging of the hand and wrist. Part I. Normal anatomy

Radiology

High-field MR surface-coil imaging of the hand and wrist. Part II. Pathologic correlations and clinical relevance

Radiology

Original communication
Glomus tumor imaging: Use of MRI for localization of occult lesions☆,☆☆