GLOMUS TUMOUR

Moderator:
Prof.P.Umananda
Dr.Mayur

Mallya

Rai
Presented

by:

Dr.Binoy.P.S
Date:

27-02-07

 SYNONYM

Glomangioma
Glomulovenous

DEFINITION

malformations

It is a rare and benign tumour which is neurally

innervated arterio Venous anastomosis invested
by specialized perivascular muscle cells (Glomus
cells ).
First described by MASSON in 1924

INCIDENCE
0.06

Male

: Female - 1:3

Age

range : 16-70 years ( most common

between 20-40 years )

Mulitiple

glomus tumour accounts <10%

TYPES
Single

Multiple
Regional
Disseminated
Congenital

PATHOGENESIS
Factor

that initiates abnormal proliferation of

glomus cells to become Glomus tumour is
unknown

Most

cases are sporadic

Familial

cases shows autosomal dominant

Inheritance with incomplete penetrance
- Defective glomulin gene located on
chromosome 1

Normal glomus body & glomus tumour

supplied by

Afferent arteriole
A-V anastomosis
(SUCQUET HOYER CANAL)

Emissary vein

SUCQUET HOYER CANAL

Lined

by plump endothelium and surrounded by

circular & longitudinal layers of smooth muscle
fibres.
Scattered

between the smooth muscle

fibres are , epithelial like modified
smooth muscle cells and each cell is
surrounded by a sheath of reticulin &
known as GLOMUS CELL

PATHOLOGICAL FEATURES
Tanned

to bloody & soft and

friable
Size : upto 2cm
Microscopy
Cells

round to oval with round

nuclei in light to dense granular
pink cytoplasm.
Anaplasia is absent and
mitoses are rare to absent.

Electron microscopy
Resemble smooth
muscle cells
( smooth muscle
cells are glycogen
positive.. glomus
cells: glycogen
negative )

SPECIAL STAINS
Reticulin:
stains

reticulin fibres around glomus

cells
PAS:
stain

cell boarders

CLINICAL FEATURES
Glomus

tumour can arise from

Extremities

(hand), Rectum, cervix,

mediastinum, eye lid, nose, chest wall,
mesentery

Most

common site

Subungual

forearm

region of fingers followed by

 Single

lesions : painful
Multiple lesions : cosmetic concerns
Affected
Bluish

nail

red flush.
Dystrophic changes in
the nail.
Pain & tenderness on
exposure to cold and
pressure.
Subungual glomus
tumour can hollow out
terminal phalanx by
pressure erosion.

Skeletal involvment
Rare
Most

not primary tumours

Can erode into bone from an adjacent
subcutaneous site
Involve distal phalanx of finger
Primary tumours Perivascular cells
- Gloumus cells

 Hildreth

sign : Disappearance of pain

after application of a tourniquet proximally
on the forearm

Love

test : Eliciting pain by applying

pressure to a precise area with tip of a
pencil

RADIOLOGICAL FEATURES

Less than 1cm eccentric,

well demarcated, convex,
circular to crescent
shaped lesion that abuts
the soft the soft tissue

A sclerotic internal rim is

often present

Overlying cortex is
markedly attenuated

MRI

DIFFERENTIAL DIAGNOSIS
Subungual

melanoma
Osteomyelitis
Epidermal inclusion cyst
Metastatic carcinoma
Osteoid osteoma

TREATMENT
Well

circumscribed lesions : curettage /

local excision with 1cm margin

Extensive
Argon

: irradiation

& carbon dioxide laser therapy

Sclerotherapy

with hypertonic saline or

sodium tetra decyl sulfate

PROGNOSIS
Excellent
Recurrences

are rare