Subungual Glomus Tumor Research Articles

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.

Outcomes of the Transungual Approach in 56 Consecutive Digital Subungual Glomus Tumours.

Background: Glomus tumour is a painful small tumour of the glomus body commonly located under the nail bed. The aim of this study is to evaluate the correlation of clinical diagnosis with MRI findings, determine the prevalence of the tumour at different subungual locations and determine the differences in outcomes (if any) between a longitudinal and a transverse nail bed incision for excision of the tumour. Methods: This retrospective study of 56 subungual glomus tumour was conducted from May 2010 to December 2021. Data with regard to gender, age at presentation, digit involved, presenting symptoms, duration of symptoms, clinical signs, need for MRI, anatomical location, surgical approach (longitudinal versus transverse), histopathology result, period of follow-up and complications were recorded. Results: All 56 (100%) patients presented with classic triad of symptoms. The average duration of symptoms was 52.9 months (range: 3-204 months). Eleven (20%) tumours were in the sterile matrix, 38 (68%) at the junction of sterile and germinal matrix and 7 (12%) in the germinal matrix. The tumours were excised through the longitudinal incision in 31 (55.3%) patients and transverse incision in 25 (44.7%). One (1.8%) tumour was intraosseous that was diagnosed intraoperatively and excised successfully. Average follow-up was 35.4 months (range: 6-120 months). There was no difference in outcomes (pain or nail deformity) between the two incisions. One patient (1.8%) has persistent pain that was due to a missed satellite lesion in the same digit. This was excised later with resolution of symptoms. There were no recurrences and all patients were cured after excision of tumour. Conclusions: Diagnosis of glomus tumour is usually clinical, and most are located at junction of sterile and germinal matrix. Tumour can be excised either by longitudinal or transverse nail bed incisions without any change of treatment outcome. Level of Evidence: Level IV (Therapeutic).

High-frequency ultrasonography for subungual glomus tumor evaluation - imaging findings.

This article aimed to describe the common imaging features of subungual glomus tumors. The study involved data collected between January 2019 and December 2022. Twenty-three patients with a total of 31 glomus tumors underwent high-frequency ultrasound examinations with a 24-MHz probe. Two experienced radiologists independently evaluated the images, and only data from the more experienced radiologist were used for subsequent analyses. The average size of the tumors was 4.6 mm, and most of them appeared homogeneously hypoechogenic (90.3%). Bone remodeling of the distal phalanx was observed in 87.1% of cases, with an average axial circumference loss of 0.8 mm, indicating the slow and expansive growth of glomus tumors. Intense vascularization was found in 54.8% of cases on Doppler images, and the stalk sign, reflecting the vascular origin of the tumor, was present in 64.5% of cases. The most common clinical feature was pain, reported in 84.6% of cases, with a mean pain scale score of 7.0, indicating a negative impact on patients' lives despite being benign tumors. The study concludes that ultrasound evaluation is highly useful for diagnosing glomus tumors, especially when multiple findings, such as bone remodeling, hypervascularization, and the stalk sign, are present. This method allows for accurate diagnosis, observation of periungual structures, and proper surgical planning, ultimately reducing recurrence rates.

Subungual Glomus Tumor of the Hallux A Report of 4 Cases.

This study reports the clinical outcomes and evolution of 4 patients with subungual glomus tumor (GT) of the hallux treated with tumor excision. Preoperatively, all patients had pain of intensity 9 or 10. Three were sensitive to cold and had stabbing pain, and one reported pulsatile pain. No patient presented nail alterations. There were no bone alterations on radiographic images and diagnostic suspicion of GT was supported by magnetic resonance images. Surgical treatment was indicated due to severe pain and functional limitation. The GT excision was performed by removing the nail through an L-shaped incision in the nail bed. After surgery, they all showed clinical improvement with return to previous activities and had no difficulty in wearing regular shoes. Three patients were pain-free and one had occasional stabbing pain of intensity 2. Half of them had nail changes. There has been no recurrence so far. Thus, we found that resection of subungual GT of the hallux was effective for the clinical improvement of patients.Level of Evidence: IV, case reports.

Retrospective analysis of clinical findings and radiologic diagnostic methods of subungual glomus tumor: a single-center study

Retrospective analysis of clinical findings and radiologic diagnostic methods of subungual glomus tumor: a single-center study

Clinical Characteristics and Results of Transungual Excision of Subungual Glomus Tumor

IntroductionGlomus tumor is rare and subungual location of the distal phalanx is the most common site. Surgical excision is the mainstay of treatment to relieve the symptoms. The objective of this study was to analyze the clinical characteristics and result of transungual excision of the tumor.MethodsA retrospective cross sectional study of was conducted among 15 cases of subungual glomus tumors operated with transungual excision over 8 years period in the department of Orthopedics. The clinical and demographic characteristics were noted from the case record. The outcome variables were assessed from case records, OPD visits, and telephone interviews and the results analyzed were pain relief, postoperative recurrence, nail deformity, and patient satisfaction. Data was analyzed by using descriptive statistical tools in SPSS-20.ResultsThe mean age of the patients was 32.6 years with the mean duration of symptoms 1.8 years. The mean tumor size was 3.4 mm. Pain and pinpoint tenderness were present in all 15 cases and positive cold sensitivity test and positive Hildreth’s test in 13 (86.7%) and 10 (66.7%) cases respectively. All cases had complete relief of pain within 2 weeks of the operation. There was no case of recurrence and nail deformity till a minimum of 1 year of follow up.ConclusionsThe diagnostic clinical triad of pain, point tenderness, and cold sensitivity are the most common findings. The transungual excision of the tumor can give rise to excellent results with complete relief of pain in all cases with no recurrence or nail deformity.

A Case of Glomus Tumor; Missed Diagnosis as Enchondroma For Previous 13 Years

Rare benign tumors called subungual glomus tumors that develop from the glomus body can cause sharp discomfort under the nail. This case involves a 38-year-old female patient who has been complaining of severe pain above her left thumbnail for 13 years. Under general anesthesia, a transungular technique was used to remove the tumor mass, and histology revealed a subungual glomus tumor. To lessen the damage and deformity to the nail bed, the tumor mass must be completely removed. To get the right diagnosis, it's crucial to consider specific clinical traits such as intense pain, regional soreness, and cold sensitivity. The diagnosis can be verified, and the tumor mass can be located with the use of a physical examination and imageology.

A subungual glomus tumour of the finger with five reappearances: a rare case report

A subungual glomus tumour of the finger with five reappearances: a rare case report

Modified trapdoor procedure versus complete nail removal for subungual glomus tumor excision at minimum 2 years follow-up

Modified trapdoor procedure versus complete nail removal for subungual glomus tumor excision at minimum 2 years follow-up

Comparison of Subungual Glomus Tumours in Terms of Nail Aesthetics and Recurrence According to Size and Location in the Germinal or Sterile Matrix.

The aim of this retrospective study was to investigate the effect of subungual glomus tumour size and localization in the germinal or sterile matrix on tumour recurrence and aesthetic outcomes. From 35 patients who underwent surgery for a subungual glomus tumour between February 2013 and February 2020, 26 patients - 17 women and 9 men - with 27 subungual glomus tumours fulfilled the inclusion criteria. The average age was 37.3 (22-58) years. According to the patients' surgical notes and preoperative magnetic resonance images 14 tumours were located in the sterile, 13 in the germinal matrix, and the mean size of the glomus tumours located in the germinal matrix was 4.9±1.7 mm, in the sterile matrix 3.6±1.0 mm. At the postoperative 12th month follow-up visit nail aesthetic was evaluated objectively according to Zook's fingernail appearance scoring. In addition, patients were asked to evaluate the pain and nail appearance in the involved finger by VAS (Visual Analog Scale 0-10). Patients who experienced recurrence were noted. No significant Zook's fingernail appearance score differences were observed between germinal and sterile matrix groups (p=0.097). Comparison of VAS score for pain and VAS score for nail appearance between the two groups also yielded similar values (p=0.449 and 0.395, respectively). The recurrence rate was similar at both locations (p=0.557) with 3 recurrences in the germinal, and 2 in the sterile matrix group. There was no relation between tumour size, Zook's fingernail appearance score (p=0.874) and recurrence (p=0.784). The observed germinal matrix glomus tumours were significantly larger than the sterile matrix tumours (p=0.031). Neither subungual glomus tumour size nor localization in the germinal or sterile matrices has different effects on nail appearance and recurrence.

Clinico-epidemiological profile and management outcome of subungual digital glomus tumor-Indian experience.

Glomus tumors are rare tumors arising from the mesenchymal smooth muscle cells of the glomus body. They are extremely painful tumors but because of their subungual location, remain mostly underdiagnosed. To characterize the demographic, clinical, onychoscopic, radiological features and management outcome of subungual glomus tumor. Material & methods- 15 patients with a total of 16 subungual glomus tumors were evaluated and their demographic data, history, clinical features, investigations, treatment, and follow-up were analyzed. Glomus tumors had a female preponderance (11/15) with thumb being the commonest site. All patients presented with intractable pain. Nail discoloration was observed in 11/16 (68.8%) lesions and nail plate deformity in 6/16 (37.5%) lesions. Common features on onychosocpy were pink glow and linear vascular structures. Doppler sonography and/or magnetic resonance imaging confirmed the diagnosis of glomus tumor in all the lesions. Surgical excision was done under local anesthesia using a trans-ungual approach and no recurrence was seen. High index of suspicion, meticulous clinical assessment along with radiological investigations can help in the early diagnosis. Complete surgical excision is the treatment of choice to prevent recurrence.

Nail sparing and sub-nail bed approach for the excision of subungual glomus tumors

Purpose: The excision of subungual glomus tumors on the distal phalanx may cause nail deformities. Herein, we report our nail-sparing and sub-nail bed approach for the excision of subungual glomus tumors, which enables subungual glomus tumor excision without removal of the nail plate and further allows access to the tumor mass by dissecting beneath the nail bed and germinal matrix to minimize postoperative pain and nail bed injury. Therefore, the present article describes this operative approach and reports surgical outcomes with respect to patient satisfaction, pain, and the final postoperative nail shape.Methods: Thirty-two cases of clinically diagnosed subungual glomus tumors treated with this approach were retrospectively evaluated. Mean pain scores were measured at 1 week postoperatively and at the last follow-up. Patients were asked for their subjective opinion regarding the final nail shape, and their responses were assessed as “satisfied” or “unsatisfied.” The objective results for the final nail shape were graded as “excellent,” “good,” or “poor” by two orthopedic hand surgeons.Results: The mean postoperative pain score (visual analog scale) at 1 week was 1.8. No patients reported pain at the last follow-up. Subjectively, 96.6% of patients were satisfied with the operation. Objectively, the postoperative nail shape was excellent in 9.3% of cases, good in 87.5%, and poor in 3.1%.Conclusion: This approach provides minimal postoperative pain, high patient satisfaction, and favorable cosmetic outcomes with respect to the nail shape by avoiding removal of the nail plate and incision of the nail bed and germinal matrix.

Subungual Glomus Tumor: A Review of 15 Cases Treated with Partial Nail Plate Excision Technique

Background: Although there are various surgical methods for subungual glomus tumor treatment, there is no consensus on the optimal surgical approach.
 Methods: We analyzed the outcomes of 15 patients treated with partial nail plate excision technique. The medial or lateral section of the nail plate was excised longitudinally based on the tumor location. After incision of the nail bed and tumor removal, the matrix was repaired carefully.
 Results: In this study, 15 people, including 11 men and four women, were studied. The mean onset of symptoms until diagnosis was 88 months. In the postoperative evaluation, the mean follow-up was 20 months. Two patients had recurrent tumors, and one had postoperative nail deformity.
 Conclusion: Meticulous nail bed repair and complete tumor excision are key treatment points needed to prevent nail deformity and recurrence.

Management of Sub-ungual Glomus Tumor of the Finger Tips

Background: Glomus tumors present as painful lesions especially in colder weather, most commonly at finger tips. Glomus tumors are hamartomas that account for 1% to 5% of all soft tissue tumors of the hand. These tumors are usually benign. High-resolution magnetingresonence imaging (HR-MRI) is useful in the diagnosis of patients with subungualglomus tumor, excellent diagnostic informationin detecting the occult lesion. Objective: present study was aimed at delineatingcommon presentation and long term treatment outcome. Materials & methods: This prospective study was done from January 2004 to july 2019. We found 30patients diagnosed as having sub-ungualglomus tumorsin finger tips and thumbover 15 yearsperiod and which were operated in hand unit in the Department of orthopaedic surgery, Bangabandhu Sheikh Mujib Medical university (BSMMU) Dhaka, Bangladesh. The data were collected included demographics, presenting symptoms, duration, physical examination, treatment and recurrence. Results: The mean duration of symptoms before presentation was 3.2 years (range 6 months to 15 yrs) Mean age at presentation was 33.7 years (range 20 to 65 yrs.) andfemale to male ratio 20:10. Thirteen (13) patientshad left hand involvement among them ring finger were 06, index finger were 04, middle finger were 02, and thumb 1 and 17 patients had right hand involvement amongthem ring finger were 06, index finger were 05, middle finger were 03 and little finger were 03. Clinical and radiological assessment were made preoperatively. All the lesionsinvolvedthe sub- ungual region. The mean size of the lesion was 3.5 mm (range 2.5 to 10mm). All the patients confirmed by histopathological examination. No recurrence in this study and nail change were 03. Transungual approachto be simple procedure which can reduce the chances of recurrence by allowing examination of entiresub ungual region. Nail deformities are minimal if adequate care is taken during surgery. Conclusion: The diagnosis of glomus tumor is largely clinical butHR-MRI is also helpful in diagnosis of patient with sub- ungualglomus tumor. Complete surgical excision offers the only prospect of complete cure. Early diagnosis of glomus tumor is important to avoid lengthy treatment delays.

Clinical and onychoscopic characteristics of subungual glomus tumor: a cross-sectional study.

Subungual glomus tumor is a relatively uncommon entity with varied clinical presentations which may lead to diagnostic delays. Onychoscopy can be used as an evaluation tool in routine evaluation of glomus tumors. With an aim to characterize the onychoscopic features of subungual glomus tumors, we analyzed 15 cases presenting over 3years, in this observational study. The clinical, onychoscopic, radiological, and operative findings in these patients were evaluated and correlated depending on the location and extent of the lesions. All 15 patients (11 female and 4 male) had pain as the presenting symptom and fulfilled the classic triad of paroxysmal pain, cold sensitivity, and positive Love's pin test. Clinical nail plate findings included onycholysis, onychorrhexis with distal splitting, and onychoschizia, while nail bed and matrix findings included localized erythematous and bluish patches, longitudinal erythema, and altered lunula. Onychoscopy corroborated the clinical findings and revealed a more extensive area of involvement in five cases. Definitive onychoscopy findings included a localized structureless erythema interspersed with bluish and patchy whitish areas (five cases of nail bed and six nail matrix tumors) and a "candy-cane appearance" (six cases, all large and lobulated nail matrix tumors). MRI reported the tumor in 13 cases, while two nail matrix tumors were missed. Transungual excision revealed tumors larger in size than predicted by MRI. The presence of candy-cane appearance was consistent with lobulated matrix tumors. Onychoscopy improves the intraoperative detection of location and extent of subungual glomus tumors. Nail bed and nail matrix glomus tumors can have distinctive onychoscopic features that may help in better surgical planning.

Subungual glomus tumour excision: The nail plate flap technique

Subungual glomus tumour excision: The nail plate flap technique

15240 Modified transungual approach with nail preservation for subungual glomus tumor: A 13-year evaluation and experience in a medical center in Taiwan

Background: Glomus tumors are benign neurovascular neoplasms, commonly in subungual region. The clinical presentation appears as intense pain, cold sensitivity, and severe tenderness of the involved digits or toes. The permanent nail deformity and recurrence is not uncommon after conventional surgery Objective: This study was designed to evaluate the long-term efficacy of the modified transungual approach with nail-preservation for removing subungual glomus tumors.

A distal curved incision approach of lunula for treatment of subungual glomus tumor in nail root

To investigate the feasibility and effectiveness of the distal curved incision approach of lunula in treating subungual glomus tumor in nail root. Between March 2017 and October 2019, 16 patients (16 fingers) with subungual glomus tumor in nail root were treated. There were 2 males and 14 females with an average age of 35.3 years (range, 21-67 years). The disease duration ranged from 5 months to 17 years, with a median duration of 15 months. There were 6 cases of thumb, 3 cases of index finger, 2 cases of middle finger, 4 cases of ring finger, and 1 case of little finger. All of them showed typical "triad syndromes", and the cold sensitivity test and Love test were positive before operation. Each patient removed the nail, the tumor was exposed under the nail bed via the distal curved incision approach of lunula. After the tumor was removed completely, the nail bed was reducted in situ without suturing. The self-made nail template was pressurized and fixed on the surface of the nail bed with suture. The conditions of nail bed healing, pain, and growth of nail were observed after operation. All wounds of the nail bed with laceration healed by first intention. Postoperative pathological results confirmed the diagnosis of subungual glomus tumor in all the patients. All cases were followed up 3-26 months with an average of 15 months. The pain symptom disappeared and no obvious pain occurred during dressing change in all cases; and the cold sensitivity test and Love test were negative. The nails recovered smoothly with satisfactory appearance, and no obvious complications such as longitudinal ridge deformities or recurrences was observed. The treatment of subungual glomus tumor in nail root via the distal curved incision approach is an effective method, which can easily operated, resect the tumor completely, protect the nail bed effectively, and also has a significant effect on preventing postoperative nail deformity.

Eponychial flap elevation method for surgical excision of a subungual glomus tumor.

The clinical symptoms of glomus tumors are pain, tenderness, nail discoloration, and cold intolerance. The only treatment for subungual glomus tumors is surgical removal. In this clinical study, we present an eponychium preserving method as a new innovative surgical approach for subungual glomus tumor. We retrospectively reviewed the data of 27 patients with subungual glomus tumors who underwent tumor resection using the eponychial flap elevation method between March 2010 and 2019. After the excision of the subungual glomus tumor using the eponychial flap elevation method, wound problems, severe pain, and nail deformity other than a minimal scar were not noted. The innovative eponychial flap elevation method is a simple and straightforward method for the management of subungual glomus tumors; the tumors can be sufficiently exposed and completely excised using this method while avoiding secondary nail dystrophy. This method can be another option among several methods of subungual glomus tumor removal.

Ultrasound features of the subungual glomus tumor and squamous cell carcinomas.

Nail tumors often pose a significant challenge for the clinician, as they are burdened by a high delay in diagnosis and paucity of clinical signs in the early stage. In most cases, the onset of pain or nail plate dystrophy leads to imaging investigations such as plain radiography, magnetic resonance imaging, and ultrasonography (US) when surgery is pending. A 2-year monocentric study evaluated the histologically confirmed cases of subungual glomus tumor (GT) and squamous cell carcinoma (SCC) with a pre-surgical US assessment, and reviewed their sonography features. A total of 7 digital GTs and 6 SCCs of the nail were collected. GT and SCC are easily distinguishable on US. Compared to SCC, GT was positively associated with an ovoid shape, well-defined borders, bone cup-scalloping without cortical erosion, and a rich intralesional vascular pattern (P < 0.05). Vice versa, SCC was significantly correlated with irregular shape, ill-circumscribed margins, an infiltrative growth pattern with peripheral hypoechoic foci, posterior acoustic shadow, cortical erosion, and a highly vascular multipolar peripheral pattern (P < 0.05). The rapid assessment of GT and SCC sonographic features may contribute to reduce diagnostic delay, expedite management, and decrease the risk of surgical relapse.