Glomus Tumor Research Articles

Glomus tumors in the urinary tract: a rare case and literature review

Background: The Glomus tumor is a rare mesenchymal tumor that predominantly affects the subcutaneous skin of the distal extremities. Solid organs are rarely affected, and the urinary tract has been the reason for isolated reports. This paper reviews the occurrence of glomus tumors in the entire urinary tract. Case Report: We report a case of a 56-year-old female, asymptomatic, with a 5.5 cm renal glomus tumor, and review the literature about the urinary tract involvement by this rare neoplasia. Conclusion: Glomus tumor mostly behaves as a benign lesion that rarely affects solid organs, being the kidney, the most affected organ in the urinary tract. It should be considered in the differential diagnosis of another renal cell tumor, especially those that are eosinophilic.

Deciphering the enigma of glomus tumors: A case series

Glomus tumors are rare contributing to less than two percent of all soft tissue tumors. Given the rarity of this tumor, there is a possibility of low suspicion and a missed clinical diagnosis. This case series suggests diagnostic and morphological clues for early diagnosis of this tumor.This retrospective study includes nine interesting cases of glomus tumors from January 2015 to January 2024. Data was tabulated and analysed by descriptive statistics using Microsoft Excel 2016. In this series the glomus tumors showed a mean age of (37.67± 17.5 years). Male to female ratio was 1.25:1. Most common sites were digital parts of extremities (5/9, 55.56%). Four of these digital locations were subungual (4/5, 80%). The left side (5/9, 55.56%) was the most common laterality. Duration of symptoms till diagnosis was established showed a median of three months [range was one month to nine years]. All nine cases presented with pain. The mean size of glomus lesions was 2.1±1.5 cm). Multiplicity was observed in (2/9, 22.22%) cases. Eight cases were benign (8/9, 88.89%) while one was malignant (1/9, 11.11%). Two out of these eight benign cases were glomangiomatosis. Excision biopsy was the surgical procedure performed in all of our benign cases while the malignant case was treated with amputation of the finger.Diagnosis of glomus tumors requires a high index of clinical suspicion, especially in extra-digital locations. Awareness is essential for early diagnosis and treatment of this lesion, as it is an extremely painful condition and pain is out of proportion to the size of the lesion. Magnetic Resonance Imaging (MRI) is the first investigation of choice for imaging. An early biopsy can confirm the diagnosis of a glomus tumor in time. Complete surgical excision is curative with a low risk of recurrence.

Malignant Esophageal Glomus Tumor With CARMN::NOTCH2 Fusion: An Additional Tumor Underscoring the Frequent Tendency of Esophageal Glomus Tumors for Aggressive Behavior.

Malignant glomus tumors are rare tumors of pericytic origin with a propensity to develop in the upper gastrointestinal tract. Hereby we demonstrate a tumor of a 20-year-old man, who presented with dysphagia and an exophytic esophageal mass. Histologic examination of the resected mass revealed a multinodular tumor in the esophageal wall composed of epithelioid cells showing nesting and monomorphic atypia, staghorn vessels and scanty stroma. Immunohistochemically, the neoplastic cells were positive for SMA, and H-caldesmon, while desmin was negative. Collagen IV and laminin decorated a dense intercellular basal membrane meshwork. RNA-sequencing using TruSight RNA Pan-Cancer Panel revealed a CARMN::NOTCH2 fusion, that is a recurrent, frequently described and so far specific genetic alteration in glomus tumors. In spite of the adjuvant chemotherapy regimens, the patient died of disseminated metastatic disease 2 years after the diagnosis. Our patient presentation and the previous reports in the literature highlight the frequently aggressive behavior of glomus tumors arising in the esophagus.

Extradigital Symplastic Glomus Tumor and Review of the Literature.

Symplastic glomus tumors are a rare subtype of glomus tumor defined by nuclear atypia without additional markers of malignancy such as large size, deep location, or atypical/prevalent mitotic figures. Glomus tumors, including the symplastic subtype, most commonly present in the subungual area with rarer extradigital presentation. To our knowledge, there have been less than 25 cases of symplastic glomus tumors described in the literature. Herein, we present a case of extradigital symplastic glomus tumor with review of the literature.

Gastric Glomus Tumor Resected by Submucosal Tunneling Endoscopic Resection

ABSTRACT Gastric glomus tumor (GGT) is a rare mesenchymal neoplasm, that is usually asymptomatic. Although benign, malignant transformation has been reported. A 59-year-old man presented with dyspepsia refractory to treatment with proton-pump inhibitor over 6 months. Esophagogastroduodenoscopy revealed a 30 mm subepithelial lesion in the distal gastric antrum, in contact with the pylorus, but biopsies were nonspecific. Upper endoscopic ultrasound revealed a well-defined submucosal echogenic lesion measuring 30 × 20 mm, without muscularis propria involvement. A fine-needle aspiration biopsy showed GGT features. En bloc endoscopic resection was performed using the submucosal tunneling endoscopic resection technique. The histopathological study of the specimen confirmed the diagnosis of a GGT with free margins. The patient remains symptom-free after a 9-month follow-up. We highlight the rare diagnosis of GGT and the possibility of curative en bloc endoscopic resection with submucosal tunneling endoscopic resection.

Presacral glomangioma: a rare localization of glomus tumors: case report

Introduction and importance: Deep located glomangiomas are rarely reported. Because of their scarcity, treatment strategie is hard to establish. Herein, we report the first case to our knowledge of presacral glomangioma. Case presentation: A 34-year-old female patient, with no previous medical history, consulted for 2-month-old pelvic abdominal pain, vomiting and delayed menstruation. Her physical and biological parameters were with no abnormalities. MRI of the pelvis demonstrated a 14 cm mixed heterogeneous pre-sacral lesion pushing the rectum anteriorly. She was operated on via a laparoscopic approach. Division of Douglas’ pouch and pelvic peritoneum laterally to the bladder showcased a cystic lesion of 13×8 cm occupying the pelvis while deviating the rectum anteriorly. Its content was aspirated and left membrane was extracted in a sac. The postoperative course was uneventful. Discussion: Presacral masses are hard to treat because of their large heterogeneity. Surgical resection should be tempted to retrieve the definitive histological diagnosis and relieve the patient. However, the surgical route is controversial as each approach has its advantages. Thus, the surgical route should take into consideration the lesion’s size, height and surrounding contacts, the patient’s functional state and surgeon’s expertise. Conclusion: Presacral glomangiomas carries low malignant pattern but should be resected to offer histological diagnosis. The surgical route remains at the surgeon’s decision, with the main objective to totally resect the encountered lesion without causing functional and sexual complications or harm to surrounding viscera.

Expanding the dermatological acronym from BLEND TAN EGG to PEGG: A rare case of painful palmar neurofibroma

Painful skin tumors present a diagnostic challenge due to their diverse presentations. The acronym blue rubber bleb nevus, leiomyoma, eccrine spiradenoma, neuroma, dermatofibroma, tufted angioma, angiolipoma, neurilemmoma, endometrioma, granular cell tumor, and glomus tumor (BLEND TAN EGG) encompasses some of the common causes of painful skin tumors. This case report documents a 24-year-old woman presenting with a painful, solitary palmar nodule confirmed as a neurofibroma after an excisional biopsy. Neurofibromas are frequently asymptomatic, but their location within the tight palmar fascia can lead to significant discomfort. The rarity of this presentation and the difficulty in pre-operative diagnosis highlight the importance of considering palmar neurofibromas as a differential diagnosis for painful skin tumors, particularly in the hand and feet. To enhance the educational value of the existing acronym, we propose its expansion to “BLEND TAN PEGG,” where “P” signifies palmar or plantar neurofibroma.

Gastric glomus tumor with a rare presentation: a case report and review of the literature

Introduction and Importance: Gastric glomus tumors (GGT) are rare soft tissue tumors of the gastrointestinal tracts (GIT). It is somewhat challenging to establish the diagnosis of GGT and differentiate it from the more common submucosal neoplasms. Case Presentation: A 34-year-old female patient presented with upper gastrointestinal bleeding. Extensive workup including endoscopic ultrasonography (EUS) revealed a well-circumscribed isoechoic mass arising from the muscularis propria. Based on fine needle biopsy (FNB) findings, with H&E stains performed only initially, the mass was considered a neuroendocrine tumor (NET). Antrectomy with Billroth II anastomosis was performed. A microscopic and immunohistochemical studies of the resected specimen showed the cells to be positive for smooth muscle actin (SMA) making GGT the final diagnosis. Clinical Discussion: Of the 116 patients included in our analysis, 56.9% (n=66) were females and age group was between 41-64 years old in 63.8% (n=74) of the patients. About 55 cases (47.4%) had abdominal or epigastric pain or discomfort, which was the most frequent clinical symptom. In immunohistochemistry, SMA staining is present in 68.1% of the cases, underscoring its diagnostic significance. Laparotomy with wedge or partial gastrectomy was employed in 46.1% of the recorded cases. Due to malignant potential, long-term follow-up and monitoring are usually recommended. Conclusion: Despite the rarity of GGT, they should be included in the differential diagnosis of gastric submucosal tumors, with immunohistochemistry studies playing a major role in the diagnosis. Furthermore, a comprehensive evaluation of the literature in the past eight years was presented in a table.

Successful Subungual Glomus Tumor Removal: A Case Report and Future Guidance on Diagnosis and Treatment

Background: Glomus tumors are rare benign hamartomas of the glomus body that occur mostly – though not limited to - the distal phalanxes of the digits. This article provides a real-life example of successful rare disease identification and treatment. It also provides a guideline that may help serve as future guidance on diagnosis and treatment. Case: A 41-year-old male came to our hospital presenting with a chief complaint of episodes of throbbing pain, which occurred spontaneously on the left thumb for the past two years. The pain had worsened in the past two weeks. The patient was positive for Hildreth’s, Love’s pin, and cold sensitivity tests. The previous x-ray showed no abnormalities in the left thumb. MRI found a hyperdense subungual lesion in the dorsal interphalangeal joint of the left thumb. We then performed an excision using the transungual approach. Histopathological findings found a relatively well-circumscribed lesion of the glomus apparatus absent of abnormal mitosis and necrosis. Two months after the excision, the patient reported no symptoms of recurrency, nail deformity, or other adverse outcomes. Conclusion: Patients typically present a chief complaint of chronic paroxysmal throbbing nail pain that persists for years, increases following exposure to cold environments, and is disproportionately exacerbated with the slightest touch. Hildreth’s, Love’s Pin, and cold sensitivity tests are special examinations that elicit or suppress pain. As with most benign tumors, complete excision usually yields good results. Adequate knowledge about diagnostic methods will help patients achieve early intervention and cure.

Atypical Gastric Glomus Tumor of Uncertain Malignant Potential in A 16-Year-Old Female; A Rare Entity with Unique Findings

Abstract Introduction/Objective Gastric glomus tumor (GGT) is a rare mesenchymal tumor that is challenging to diagnose, especially when the immunoprofile overlaps with other more common gastric mesenchymal tumors. The majority of GGT are benign, however, rarely it can be atypical or even malignant. Herein, we present a case of a young female with atypical gastric glomus tumor of uncertain malignant potential. Methods/Case Report A 16-year-old female presented to the emergency with abdominal pain, coffee ground emesis, and melena. Imaging showed a 3.2 cm well-defined gastric mass arising from the muscularis propria. Results (if a Case Study enter NA) The FNA biopsy revealed clusters of tumor cells with uniform characteristics, exhibiting distinct cell membranes and eosinophilic to clear cytoplasm, surrounding prominent vasculature. Immunohistochemical analysis showed that the tumor cells were positive for SMA, synaptophysin, vimentin, calponin, and caldesmon, with weak, patchy positivity for DOG1. CD34 highlighted the vessels separating the tumor cellular clusters into lobules. CD117 and Desmin were negative. The Ki67 proliferation index varied with hotspot foci 25-30%. Morphology and immunoprofile suggest glomus tumor, however, neuroendocrine tumor and epithelioid GIST needed to be excluded. Subsequent resection specimen showed that the tumor was located within the muscularis propria with extension into the serosal vessels, suggesting vascular invasion, along with foci of cellular spindling and nuclear irregularity are identified. No necrosis noted. Tumor cells were positive for cyclin D1 while negative for myogenin, chromogranin, and DOG1. Overall, findings were consistent with GGT of uncertain malignant potential. Conclusion Although GGT are rare, they should be considered in the differential diagnosis of gastric mesenchymal tumors. The presence of diffuse SMA staining can help distinguishing them from GIST. It is crucial to scrutinize for signs of cellular and nuclear atypia, particularly in deeply seated glomus tumors.

8358 A Diagnostic Challenge: Occult Paraganglioma Misdiagnosed as Pheochromocytoma Leading to Unnecessary Adrenalectomy

Abstract Disclosure: A.R. Kasireddy: None. S. Alshami: None. S. Gummalla: None. C. Balasubramaniapandian: None. J.A. Henske: None. A. Albashaireh: None. Background: Pheochromocytomas and paragangliomas are rare neuroendocrine tumors. Catecholamine-secreting paragangliomas, like pheochromocytomas, can present with hypertension, sweating and episodic headaches. Thoughtful consideration must be given to distinguish between the two and potentially avoid a critical misdiagnosis. Case: A 61-year-old woman with hypertension and diabetes presented for evaluation of glomus jugulare discovered on CT of the head during evaluation of worsening hearing loss and tinnitus. She reported a longstanding history of episodic headaches, palpitations, anxiety spells and excessive sweating with more recent onset of ear fullness. When symptoms first presented, she had a left adrenalectomy 3 years prior. CT abdomen at that time showed 1.8 x 2.2 cm left adrenal nodule with a density of 12.2 HU and early contrast washout. Plasma metanephrines were normal but normetanephrines were elevated at 5.1 nmol/L (nl: less than 0.9 nmol/L). 24-hour urine metanephrines were normal but normetanephrines were elevated to 892mcg/24h (nl: 122-676 mcg/24h). MIBG scan was done and showed increased activity in the left adrenal nodule. Decision was made to proceed with left adrenalectomy. Surgical pathology was benign. Present evaluation after discovery of the glomus tumour with worsening symptoms showed normal plasma metanephrines, elevated plasma normetanephrines at 1529.9 pg/ml (0- 285.2 pg/ml), elevated plasma norepinephrine at 3280 pg/ml (0-874 pg/ml), with normal dopamine and epinephrine levels. CT head showed a 3 x 2.7 x 2.1 cm lytic destructive mass within the petrous temporal bone at the left skull base containing multiple internal calcifications. Given the lab and imaging findings, paraganglioma was diagnosed. Genetic testing revealed SDHB mutation. Neurosurgery consultants determined that the tumour was not amenable to resection. She was treated with radiation therapy, alpha blockade, and close blood pressure monitoring. Discussion: This case highlights the importance of reviewing the degree of hormonal elevations as well as the pattern of elevation to obtain a correct diagnosis. Paragangliomas commonly secrete normetanephrines rather than metanephrines and are often not immediately localized. Understanding the most likely genetic mutations when a paraganglioma is suspected can direct appropriate choice of radionuclide scanning agents. In this case, an earlier diagnostic scan may have prevented unnecessary adrenalectomy and facilitated earlier discovery of the paraganglioma. Presentation: 6/2/2024

Preoperative Embolization of Glomus Tumors: Role, Effectiveness, and Complications.

Purpose: Paragangliomas represent a surgical challenge due to their hypervascularization. The preoperative selective embolization of these tumors significantly decreases intraoperative blood loss. However, the literature on preoperative embolization in glomus tumors is limited. The aim of this study is to contribute additional evidence regarding the role of preoperative embolization, as well as to evaluate risks and complications in the treatment of glomus tumors. Methods: A retrospective evaluation of all the embolizations of glomus tumors from 2009 to 2023 was conducted. The primary outcome parameter was the rate of devascularization after embolization and the occurrence of significant perioperative hemorrhages. The secondary outcome was embolization-related complications. Results: Twenty-one embolizations in 20 patients were investigated in the study. In 43% of the cases more than 90% devascularization was achieved by embolization, while in the remaining cases, 80 to 90% devascularization was reached. In one case (5%), significant perioperative bleeding after embolization occurred. In one case (5%), a symptomatic complication occurred periinterventionally due to the brief dislocation of the coaxial and microcatheter into the internal carotid artery (ICA), which led to fresh punctate DWI lesions on the subsequent MRI. No patients developed nerve palsy following embolization. Conclusions: The preoperative embolization of glomus tumors can lead to significant tumor devascularization and a reduction in perioperative bleeding, with a low complication rate.

S2857 A Case of Hematochezia Secondary to a Colonic Glomus Tumor

S2857 A Case of Hematochezia Secondary to a Colonic Glomus Tumor

S4130 An Uncommon Result in a Common Finding: The Rare Case of a Gastric Glomus Tumor

S4130 An Uncommon Result in a Common Finding: The Rare Case of a Gastric Glomus Tumor

Benign glomus tumor of prostate: a case report

Glomus tumor (GT) is a neoplastic lesion of mesenchymal origin arising from the neuromyoarterial canal or glomus body. Although most GT occur in the peripheral soft tissue and extremities, these tumors can grow anywhere in the body. Here, we describe an uncommon case of GT involving the prostate.

Imaging findings of gastric glomus tumors.

Sparse literature describes the imaging findings of gastric glomus tumors (GGT), focusing on benign tumors. We are not aware of prior radiology reports on malignant GGT. The aim of the study was to determine whether it is possible to differentiate between benign and malignant GGT on CT or MR. Institutional radiology and pathology databases were queried for the diagnosis of GGT between January 2010 to December 2023. Of 22 identified subjects, five were excluded due to non-availability of preoperative CT or MR images and three due to lack of pathological confirmation in our institution. The study cohort comprised of 14 patients (males = 6) with median age of 65 years (range 31 to 79 years). Two abdominal radiologists in consensus reviewed all relevant CT and MR images. There were 10 benign and 4 malignant GGT. Benign tumors were smaller than malignant GGT (median size of 2.0cm vs. 5.3cm, p = 0.03), more likely to exhibit homogeneous hyperenhancement (9/10 vs. 0/4, p < 0.01), and demonstrated intramural rather than exophytic growth. There was no substantial difference in T2 signal or diffusion restriction between benign and malignant GGT. On follow up, benign GGT were essentially stable in size, while malignant GGT grew. A biopsy proven GGT larger than 5cm or showing necrosis is likely to be malignant. This is important since preoperative endoscopic ultrasound-guided fine needle aspiration may be indeterminate for malignancy.

Endoscopic-Guided Therapy for Tracheal Glomus Tumor: A Case Report on Radiofrequency Plasma-Assisted Therapy.

This is a case report on the treatment of tracheal glomus tumor, which is a rare tumor originating from the glomus bodies in the trachea and form spherical or nodular masses. These tumors can lead to obstruction and narrowing of the tracheal lumen, causing symptoms such as dyspnea. The standard treatment for tracheal glomus tumors is typically surgical resection. In this case, the patient underwent a procedure involving low tracheostomy with closure of the airway and mechanical ventilation through the stoma, followed by endoscopic-assisted subglottic tracheal glomus tumor resection using plasma-assisted radiofrequency.

Rapidly progressive malignant glomus tumor of the breast: a case report and review of the literature.

The glomus tumor is a rare neoplasm that is typically found subungually in the extremities and functions as a specialized neurovascular organ. An extremely rare site for glomus tumors is the breast, with only a few reported cases. Breast glomus tumors present with three typical clinical signs: dull pain, focal tenderness, and cold sensitivity. Less than 10% of all glomus tumors are malignant. We herein present a case of a malignant glomus tumor originating in the breast. Distant metastasis was ruled out, and the tumor was completely resected. However, the patient unexpectedly developed rapid systemic metastasis, detected 5 weeks after tumor removal. Despite the administration of analgesics and targeted therapy, the patient died 1 month later. When treating patients with undiagnosed breast tumors, clinicians should pay attention to unexplained and repeatedly reported symptoms and consider the possibility of a rare disease. Our literature search revealed no cases of malignant glomus tumors originating in the breast, making this case the first of its kind.

Toward a Diagnostic Imaging Algorithm for Undifferentiated Pulsatile Tinnitus.

Decisions around the diagnostic evaluation for pulsatile tinnitus (PT) remain challenging. We describe the usage patterns and diagnostic accuracy of imaging modalities and propose an evidence-based diagnostic approach for undifferentiated PT. Retrospective. Single otology/neurotology clinic. Patients with PT presenting between 2009 and 2020. Sensitivity, specificity, diagnostic yield, and diagnostic accuracy. A total of 315 subjects met inclusion criteria (74% female, mean ± SD age = 52 ± 17 years). Subjects were divided into four cohorts based on exam findings: normal (n = 229), venous cohort (n = 34), arterial cohort (n = 16), and outer/middle ear pathology cohort (n = 40). In total, 53% of patients received a nonidiopathic diagnosis for PT. The most common identifiable cause was sigmoid sinus dehiscence (78%) in the venous cohort, carotid stenosis (36%) in the arterial cohort, and glomus tumor (56%) in the outer/middle ear pathology cohort. There was a higher diagnostic rate among patients with positive exam findings compared to those with unrevealing exams ( p = 0.04). Imaging studies with the highest diagnostic yield were computed tomography (CT) venography (44%), formal angiography (42%), and magnetic resonance venography (40%); studies with the highest specificity were formal angiography (0.82), CT angiography (0.67), and CT venography (0.67). A diagnostic algorithm is proposed. Reaching a diagnosis in patients with PT requires a systematic approach, taking into account both clinical and radiographic information. Physical examination is a key first step for differentiating patients into venous, arterial, and other cohorts to narrow down the likely pathology and determine which radiographic studies have the highest yield and accuracy.

Tactics of surgical treatment of recurrent glomus tumors of the skull base: A clinical case

AimThe purpose of the study is to build effective tactics of surgical treatment of pathology, and to increase the effectiveness of surgical treatment of patients with this diagnosis by optimising preoperative preparation, and the correct sequence of actions that will help prevent relapse. MethodsThe leading approach to the study is the description of a clinical case, which will help to carefully consider this issue from all angles, analyse the methodology of patient examination, and build highly effective tactics of surgical intervention to eliminate tumour-like masses, minimising the risks of recurrence. The second clinical case was also considered, and a comparative analysis was carried out on certain parameters. ResultsThe paper presents a clinical case with a practical aspect of surgical treatment of the pathology. The issue of detailed symptoms and manifestations of the disease is disclosed, and the course of surgical interventions is described in stages, in which no nerve is damaged, no complications are caused, and the desired result is achieved. The peculiarity of this case is the recurrence of the disease, and the ineffectiveness of previous treatment methods, including embolisation of the neoplasm and antromastoidotomy. ConclusionsThe results obtained in the course of this study and the formulated conclusions are of great importance for surgeons who are faced with patients with the stated diagnosis.