Glomus tumor

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	Glomus tumor;
ICD-O:	8711/0
OMIM	138000
DiseasesDB	30732
eMedicine	derm/167
MeSH	D005918

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Glomus tumor was also the name used for a tumor now called a paraganglioma.

Overview

A glomus tumor (glomangioma) is a rare benign neoplasm, is a specialized arteriovenous anastomosis usually found in the skin of the extremities. It arises from the glomus body.

Presentation

They are usually solitary and small, and can be found under the fingernails.^[1] They can also be found on the tympanic membrane.^[2]

They are often painful, and the pain is reproduced when the lesion is placed in cold water.

These tumors tend to have a bluish discoloration, although a white appearance is also noted. Elevation of the nail bed can occurr

Frequency

United States: The exact incidence of glomus tumors is unknown. The multiple variant is rare, accounting for less than 10% of all cases. The probable misdiagnosis of many of these lesions as hemangiomas or venous malformations also makes an accurate assessment of incidence difficult.

Mortality/Morbidity

The most common adverse effect is pain, which is usually associated with solitary lesions. Multiple tumors are less likely to be painful. In one report, a patient with more than 400 glomus tumors had thrombocytopenia as a result of platelet sequestration (ie, Kasabach-Merritt syndrome). Malignant glomus tumors, or glomangiosarcomas, are extremely rare and usually represent a locally infiltrative malignancy. However, metastases do occur and are usually fatal.

Sex

Solitary glomus tumors, particularly subungual lesions, are more common in females than in males. Multiple lesions are slightly more common in males.

Age

Solitary glomus tumors are more frequent in adults than in others. Multiple glomus tumors develop 10-15 years earlier than single lesions; about one third of the cases of multiple tumors occur in those younger than 20 years. Congenital glomus tumors are rare; they are plaquelike in appearance and are considered a variant of multiple glomus tumors.

Diagnosis

Physical Examination

Ear Nose and Throat

Picture of a left tympanic membrane with a pulsating red mass occupying the inferior portion of the middle ear space. The rest of the tympanic membrane is normal^[3].
Glomus tympanicum magnified^[4].
This patient presented with a history of severe bleeding from the placement of a PE tube in her right ear. On examination, the posterior half of the tympanic membrane was red and pulsating^[5].
Surgical picture of the above patient. A tympanomeatal flap has been elevated and reflected anteriorly to expose the glomus tympanicum that filled the posterior half of the middle ear space^[6].
Axial CT scan showing the glomus tumor growing from the medial wall of the middle ear^[7].
Coronal CT scan showing the glomus tympanicum tumor growing from the medial wall of the middle ear^[8].
Surgical picture of glomus tympanicum in the eft middle ear. The tympanomeatal flap has been raised and reflected anteriorly^[9].