Glomus Tumors: Symptom Variations and Magnetic Resonance Imaging for Diagnosis
A 78-year-old female patient suffered point pain, tenderness aggravated by cold irritation, and nail irregularity in the thumb (). As described above, this patient exhibited the triad of symptoms of glomus tumor. However, she additionally presented with severe paroxysmal pain and radiating pain to the wrist as well as mild swelling at the fingertip area that suggested infection or an inflammatory lesion. Prior consultations with an orthopedic surgeon, pain clinic specialist, and also a plastic surgeon failed to establish a diagnosis. Pretreatment with non-steroidal anti-inflammatory drugs, pain killers, and antibiotics did not alleviate the symptoms. At last, MR imaging was performed as a preoperative measure to eliminate the possibility of inflammatory or neurological disease. MR imaging revealed a hypo-intense well-defined nodule on the T1-weighted images, which appeared as hyper-intense lesions on the T2-weighted images of the thumb. Nodule enhancement also appeared with gadolinium (). No other abnormal lesions on the hand and forearm of this patient were observed. MR imaging suggested that the thumb nodular lesion was a glomus tumor. Finally, the lesion was surgically excised, and complete surgical excision followed by gross pathology revealed a well-defined red-blue nodule. Histopathology of the glomus tumor showed compact nests of monotonous polygonal cells with rounded nuclei and eosinophilic cytoplasm (-). Following surgery, the patient was symptom-free without evidence of complications or recurrence.