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| CASE REPORT |
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| Year : 2021 | Volume
: 5
| Issue : 1 | Page : 34-35 |
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Ultrasonographic features of hypothenar region extra digital glomus tumor
Manohar Kachare1, Alamgir Khan1, Umesh Joshi2, Sachin Patil3
1 Department of Radiodiagnosis, Government Medical College Miraj, Miraj, Maharashtra, India
2 Sakar Nursing Home, Sangli, Maharashtra, India
3 Om Pathology Laboratory, Sangli, Maharashtra, India
| Date of Submission | 21-Oct-2020 |
| Date of Acceptance | 16-Mar-2021 |
| Date of Web Publication | 10-Apr-2021 |
Correspondence Address:
Dr. Manohar Kachare
Department of Radiodiagnosis, Government Medical College Miraj, Pandharpur Road, Maji Sainik Vasahat, Miraj - 416 410, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/LJMS.LJMS_93_20
We report a case of a 32-year-old female with a 6-month history of excruciating pain in hypothenar region of the left hand. Pain was aggravated by pressure, touch, and cold temperature. Musculoskeletal ultrasonography revealed a well-defined, hypoechoic lesion in the deep dermis and subcutaneous fat in the left hypothenar eminence with mixed arterial and venous signals within on Doppler study, suggestive of subcutaneous vascular lesion, and a diagnosis of glomus tumor was suggested. The patient underwent excision of the lesion. Pathological examination of the specimen showed a glomus tumor and excluded malignant transformation to glomangiosarcoma. Extra digital glomus tumor can be diagnosed on ultrasound with high confidence in appropriate clinical setting.
Keywords: Dermis, glomus tumor, hypothenar, subcutaneous fat, ultrasonography
How to cite this article:
Kachare M, Khan A, Joshi U, Patil S. Ultrasonographic features of hypothenar region extra digital glomus tumor. Libyan J Med Sci 2021;5:34-5 |
| Introduction | |  |
Glomus tumors are benign mesenchymal tumors of the neuromyoarterial glomus bodies and are most commonly found in the subungual area of the fingers. However, extra digital glomus tumors (EDGTs) are rare and are difficult to diagnose due to their low incidence and nonspecific symptoms and usually missed during the physical examination. On ultrasonography, EDGT typically appears as a well-defined, small, hypoechoic, homogeneous, or slightly inhomogeneous nodule, which is painful under probe pressure. Intranodular vascularity is always present.
| Case Report | | |
A 32-year-old woman presented to an orthopedic surgeon with excruciating pain in the hypothenar region of the left hand for 6 months. Pain was aggravated by pressure, touch, and cold temperature. Ultrasound (US) of the hand was done with 17 MHz high-frequency transducer in the musculoskeletal setting on Toshiba Xario systems (Otawara, Tochigi, Japan). On US, a 2.5 mm × 2.2 mm well-defined, hypoechoic lesion was noted in the deep dermis and subcutaneous fat in the left hypothenar eminence [Figure 1]. This soft tissue lesion revealed internal mixed arterial and venous signals on Doppler study [Figure 2]. At the site of the US abnormality, a small bluish lesion was seen in the hypothenar region. The lesion was excised under local anesthesia by the orthopedic surgeon and the specimen was sent for histopathological examination. The histopathology revealed a small circumscribed tumor composed of clusters of uniform round-to-oval cells with round nuclei and eosinophilic cytoplasm. The cells were perivascular in location with a few capillaries at the centers of clusters. The stroma was scant and there was no evidence of malignancy [[Figure 3]a and [Figure 3]b. These findings were consistent with EDGT. | Figure 1: A well-defined hypoechoic ovoid lesion is seen in the deep dermis and subcutaneous fat of the left hypothenar eminence on gray scale ultrasound
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 | Figure 2: A color Doppler ultrasound study showing the hypoechoic lesion with mixed vascularity
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 | Figure 3: (a) Histologically, low-power microscopic view showing tumor as a well-defined small circumscribed lesion in deep dermis and subcutaneous fat layer (H and E, ×40). (b) Medium-power microscopic view showing the tumor composed of clusters of uniform round-to-oval cells with round nuclei and eosinophilic cytoplasm along capillary cluster (H and E, ×100)
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| Discussion | | |
Glomus tumors are slow-growing benign neoplasms of the neuromyoarterial glomus bodies origin. These are usually located in the fingers and particularly in the subungual bed. However, EDGTs predominate in extremities, such as the thigh, leg, and forearm.[1] EDGTs are difficult to diagnose because of their rarity and nonspecific symptoms and may be overlooked on physical examination.[2] In this case, the patient presented with pain in the left hypothenar region, which was aggravated on pressure and exposure to the variation in temperature. Pain on temperature variation is thought to be due to reflex vasodilatation, or it may be related to contraction of myofilaments.[3]
Glomus tumor is considered to be more frequently described in young and middle-aged adults as glomus bodies are absent in children younger than 1 year of age, and they tend to atrophy in the older people.[4] On US, the lesion typically appears as a well-defined, hypoechoic, circumscribed, oval subcutaneous nodule, with slight posterior acoustic enhancement and tenderness on probe pressure.[5] Differently from hemangioma, EDGT is firm and does not change in shape under probe-mediated pressure.[3]
Although EDGT is small in size, it reveals several vessels internally. High-frequency probe with color Doppler and minimal pressure application allow the demonstration of typical, but not constant, hypervascularity. The presence of a single feeding large artery and single or multiple draining veins is very typical. Spectral Doppler study demonstrates both arterial flow and, to a relatively lesser degree, venous flow.[3] The imaging or histopathological findings reveal absent features of malignancy. It is unusual for a glomus tumor to demonstrate atypical or malignant histopathological characteristics, but malignant transformation to glomangiosarcoma and metastasizing features, such as nuclear atypia, infiltrative growth pattern, and multicentricity, although rare, have been described. Malignancy can be suspected in the presence of multiple, large, deep, and heterogeneous EDGTs.[6]
| Conclusion | | |
An EDGT is a clinically painful lesion with indeterminate signs which can be diagnosed on US with high-frequency transducer. Correlating the clinical presentation with the gray scale US and color Doppler findings is helpful to suspect an EDGT. However, histopathology is required for the definitive diagnosis of tumor.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 2. | Santoshi JA, Kori VK, Khurana U. Glomus tumor of the fingertips: A frequently missed diagnosis. J Family Med Prim Care 2019;8:904-8. [ PUBMED] [Full text] |
| 3. | Gombos Z, Zhang PJ. Glomus tumor. Arch Pathol Lab Med 2008;132:1448-52. |
| 4. | Smalberger GJ, Suszko JW, Khachemoune A. Unknown: Painful growth on right index finger. Dermatol Online J 2011;17:12. |
| 5. | Teh J. Ultrasound of soft tissue masses of the hand. J Ultrason 2012;12:381-401. |
| 6. | Dong LL, Chen EG, Sheikh IS, Jiang ZN, Huang AH, Ying KJ. Malignant glomus tumor of the lung with multiorgan metastases: Case report and literature review. Onco Targets Ther 2015;8:1909-14. |
[Figure 1], [Figure 2], [Figure 3]
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