Glomus angioma: series of cases and literature review

Glomus tumors usually occur in areas rich in glomus bodies, such as the subungual areas of the fingers or the deep dermis of the palm, wrist, and forearm, but they can also occur in deep visceral sites throughout the body, including the lungs, stomach, pancreas, liver, gastrointestinal and urinary tracts. They are thought to have originated from modified smooth muscle cells of the neuromyoarterial glomus, commonly referred to as the glomus body, whose function is to regulate temperature through arteriovenous shunting of the blood. Important during the pathological process for these tumors are pain that persists for a long time, which is often necessary for their detection and the possibility of relapse.

The purpose: to analyze and evaluate our own clinical cases of glomus angioma of various localization.

Materials and methods. 6 patients with a morphologically verified diagnosis of glomus angioma (5 women and 1 man aged 23 to 50 years, mean age 34.5 years) were treated at A.V. Vishnevsky National Medical Research Center of Surgery for the period from 2004 to 2023. All patients were operated on. Lesions localization: limbs soft tissues – 3, retroperitoneal space – 2, lung – 1.

Results. The term of the lesions detection varied from 2 months to congenital. In 2 of 3 cases of the limbs soft tissues tumors localization they were congenital. Limbs soft tissues glomus tumors: the leions ranged in size from 40.0 × 28.65 mm to a large lesion, consisting of multiple foci ranging in size from 20.0 to 60.0 mm in diameter, all tumors were multinodular. Retroperitoneal glomus tumors: the lesions were rather large (a multinodular lesion from 6.0 to 48.0 mm in diameter and a single-nodular multi-chamber lesion of a polycyclic form, 150.0 × 100.0 × 80.0 mm in size). The lung glomus tumor was single-nodular and had a diameter of 12.5 mm. In the vast majority of cases (5/6), the lesions manifested with the pain and discomfort. Only the lung lesion was detected by chance and during a routine examination.

The criteria for ultrasound and MSCT signs of the lesions of various localizations are given. The data are compared with literature data.

Conclusion. Given the rarity of glomus angioma and the lack of publications on glomus angiomas of soft tissues of the extremities and deep-seated tumors in the domestic literature, the presented analysis of a series of our own cases will increase the awareness of clinicians and diagnosticians about these tumors and, thereby, increase their detection, which will allow for earlier surgery.

1. Takei T.R., Nalebuff E.A. Extradigital glomus tumour. J. Hand. Surg. Br. 1995; 20 (3): 409–412. http://doi.org/10.1016/s0266-7681(05)80105-6

2. White C.P., Jewer D.D. Atypical presentation of a glomus tumour: A case report. Can. J. Plast. Surg. 2006; 14 (4): 237–238. http://doi.org/10.1177/229255030601400402

3. Wood W. On painful subcutaneous tubercle. Edinburgh Med. J. 1812; 8: 283.

4. Masson P. Le glomus neuromyoartérial des régions tactiles et ses tumeurs. Lyon Chir. 1924; 21: 257–280.

5. Gombos Z., Zhang P.J. Glomus tumor. Arch. Pathol. Lab. Med. 2008; 132 (9): 1448–1452. http://doi.org/10.5858/2008-132-1448-GT

6. Fletcher C.D.M. World Health Organization, International Agency for Research on Cancer. WHO Classification of Tumours of Soft Tissue and Bone. 4. Lyon, France: IARC Press, 2013.

7. Akgün R.C., Güler U.Ö., Onay U. A glomus tumor anterior to the patellar tendon: a case report. Acta Orthop. Traumatol. Turc. 2010; 44 (3): 250–253. http://doi.org/10.3944/AOTT.2010.2174

8. Abela M., Cole A.S., Hill G.A., Carr A.J. Glomus tumor of the scapular region. J. Shoulder Elbow. Surg. 2000; 9 (6): 532–533. http://doi.org/10.1067/mse.2000.108961

9. Negri G., Schulte M., Mohr W. Glomus tumor with diffuse infiltration of the quadriceps muscle: a case report. Hum. Pathol. 1997; 28 (6): 750–752. http://doi.org/10.1016/s0046-8177(97)90188-x

10. Wang Y., Li T., Lv Z. et al. Glomus tumors around or in the knee: a case report and literature review. BMC Surg. 2022; 22 (1): 97. http://doi.org/10.1186/s12893-022-01545-8

11. Stacy G.S., Cipriani N.A. Glomus tumours of the knee: a case series. Clin. Radiol. 2023; 78 (2): e123–e130. http://doi.org/10.1016/j.crad.2022.09.125

12. Stumpf N., Huang S., Pritchett E., Lee J. Glomangioma of the elbow. Dermatol. Online J. 2021; 27 (6). http://doi.org/10.5070/D327654064

13. Constantinidis J., Kiefer A., Reitnauer K., Iro H. Glomangioma of the nasal cavity and paranasal sinuses. Rhinology. 2000; 38 (3): 136–139.

14. Panickar N., Tara V.S. Rare and Atypical Presentation of Glomus Tumor in the Eyelid. Korean J. Ophthalmol. 2021; 35 (2): 171–172. http://doi.org/10.3341/kjo.2020.0113

15. Jing H., Weiwen C., Meihong C., Xiaohong G. Glomus tumour of the iris: A case report. Eur. J. Ophthalmol. 2022; 32 (1): NP203–NP207. http://doi.org/10.1177/1120672120959030

16. Bauerová L., Gabris V., Honsová E., Povýsil C. Glomus tumor of the stomach: a case report and review of the literature. Cesk Patol. 2011; 47 (3): 128–129.

17. Deng M., Luo R., Huang J. et al. Clinicopathologic features of gastric glomus tumor: A report of 15 cases and literature review. Pathol. Oncol. Res. 2023; 28: 1610824. http://doi.org/10.3389/pore.2022.1610824

18. Amoueian S., Meibodi N.T., Tavoosi H. et al. Primary glomus tumor of the liver. Arch. Iran Med. 2011; 14(4): 294–295.

19. Al-Ahmadie H.A., Yilmaz A., Olgac S., Reuter V.E. Glomus tumor of the kidney: a report of 3 cases involving renal parenchyma and review of the literature. Am. J. Surg. Pathol. 2007; 31 (4): 585–591. http://doi.org/10.1097/01.pas.0000213373.64053.41

20. Hu Y., He X., Zhang Q. et al. Primary Adrenal Glomus Tumor: The First Case Report. Urol. Int. 2022; 106 (3): 317–320. http://doi.org/10.1159/000519482

21. Shah T.S., Paton A. A catecholamine secreting retroperitoneal glomangioma. A case report. East Afr. Med. J. 1973; 50 (10): 586–593.

22. Dalfior D., Parisi A., Cannizzaro C. et al.Pulmonary glomus tumor. Int. J. Surg. Pathol. 2008; 16 (1): 81–84. http://doi.org/10.1177/1066896907304520

23. Wang S., Ding C., Tu J. Malignant glomus tumor of the lung with multiple metastasis: a rare case report. Wld J. Surg. Oncol. 2015; 13: 22. http://doi.org/10.1186/s12957-014-0423-3

24. Menaissy Y.M., Gal A.A., Mansour K.A. Glomus tumor of the trachea. Ann. Thorac. Surg. 2000; 70 (1): 295–297. http://doi.org/10.1016/s0003-4975(00)01285-6

25. Péricart S., Chiariello G.A., Massiere J. et al. Tumeur glomique intracardiaque: une tumeur péricytaire (périvasculaire) de localisation inhabituelle [Cardiac glomus tumor: An unusual localization of pericytic (perivascular) tumor]. Ann. Pathol. 2021; 41 (6): 561–566. http://doi.org/10.1016/j.annpat.2021.06.007 (In French)

26. Yalcin S., Ergul E., Ucar A.E. et al. Glomus tumor of the breast: first report. Langenbecks Arch. Surg. 2009; 394 (2): 399–400. http://doi.org/10.1007/s00423-008-0337-z

27. Barajas D. Glomus tumor of the male breast. Breast J. 2020; 26 (2): 297–298. http://doi.org/10.1111/tbj.13549

28. Tullie S.T.E., Quraishi M.K., Karawita T., Anjarwalla S. Rare presentation of a testicular glomus tumour. BMJ Case Rep. 2019; 12 (11): e230935. http://doi.org/10.1136/bcr-2019-230935

29. Tsang J.C.H., Ng C.S., Fung C.F. et al. Glomus Tumor of Sella Turcica With Synaptophysin Expression Mimicking Pituitary Adenoma. Int. J. Surg. Pathol. 2020; 28 (4): 401–405. http://doi.org/10.1177/1066896919900550

30. Michal M. Glomus tumour with intravascular spread. Cesk. Patol. 1993; 29 (4): 144–146.

31. Acebo E., Val-Bernal J.F., Arce F. Giant intravenous glomus tumor. J. Cutan. Pathol. 1997; 24 (6): 384–389. http://doi.org/10.1111/j.1600-0560.1997.tb00808.x

32. Beaton L.E., Davis L. Glomus tumor. Q. Bull. Northwest. Univ. Med. Sch. 1941; 15: 245–254.

33. Takei T.R., Nalebuff E.A. Extradigital glomus tumour. J. Hand. Surg. Br. 1995; 20 (3): 409–412. http://doi.org/10.1016/s0266-7681(05)80105-6

34. Chiang E.R., Chen T.H. Multiple glomus tumors in gastrocnemius muscle: a case report. Arch. Orthop. Trauma Surg. 2008; 128 (1): 29–31. http://doi.org/10.1007/s00402-007-0377-9

35. Folpe A.L., Fanburg-Smith J.C., Miettinen M., Weiss S.W. Atypical and malignant glomus tumors: analysis of 52 cases, with a proposal for the reclassification of glomus tumors. Am. J. Surg. Pathol. 2001; 25 (1): 1–12. http://doi.org/10.1097/00000478-200101000-00001

36. Cabral R., Santiago F., Tellechea O. Multiple glomus tumors and segmental neurofibromatosis: there are no coincidences. Dermatol. Online J. 2011; 17 (3): 4.

37. Blume-Peytavi U., Adler Y.D., Geilen C.C. et al. Multiple familial cutaneous glomangioma: a pedigree of 4 gener ations and critical analysis of histologic and genetic differences of glomus tumors. J. Am. Acad. Dermatol. 2000; 42; 633–639.

38. Enzinger F.M., Weiss S.W. (eds).: Perivascular tumors. In: Soft Tissue Tumors. 4th ed. Mosby, St.Louis, 2001: 985– 1001.

39. Mravic M., LaChaud G., Nguyen A. et al. Clinical and histopathological diagnosis of glomus tumor: an institutional experience of 138 cases. Int. J. Surg. Pathol. 2015; 23 (3): 181–188. http://doi.org/10.1177/1066896914567330

40. Riddell D.H., Martin R.S. Glomus tumor of unusual size; case report. Ann. Surg. 1951; 133 (3): 401–403. http://doi.org/10.1097/00000658-195103000-00015

41. Rao A.G., Indira D., Kamal J. Extra digital glomangioma. Indian J. Dermatol. 2010; 55 (4): 397–398. http://doi.org/10.4103/0019-5154.74570

42. Fletcher C.D.M. World Health Organization, International Agency for Research on Cancer. WHO Classification of Tumours of Soft Tissue and Bone. 4. Lyon, France: IARC Press, 2013.

43. Porter P.L., Bigler S.A., McNutt M., Gown A.M. The immunophenotype of hemangiopericytomas and glomus tumors, with special reference to muscle protein expression: an immunohistochemical study and review of the literature. Mod. Pathol. 1991; 4 (1): 46–52.

44. Watanabe K., Kusakabe T., Hoshi N. et al. h-Caldesmon in leiomyosarcoma and tumors with smooth muscle cell-like differentiation: its specific expression in the smooth muscle cell tumor. Hum. Pathol. 1999; 30 (4): 392–396. http://doi.org/10.1016/s0046-8177(99)90113-2

45. Chen J.H., Lin L., Liu K.L. et al. Malignant glomus tumor of the intestinal ileum with multiorgan metastases: A case report and review of literature. Wld J. Gastroenterol. 2020; 26 (7): 770–776. http://doi.org/10.3748/wjg.v26.i7.770

46. Xie Q., Xia Y., Zhang J., Zhu J.M. A glomus tumor with intravascular spread and multiple metastases: A case report. Asian J. Surg. 2023; 46 (2): 1099–1100. http://doi.org/10.1016/j.asjsur.2022.07.134

47. Guvendir I., Zemheri I.E., Altundal K. et al. Ossified uncertain malignant potential gastric glomus tumor with tumor thrombus. Indian J. Pathol. Microbiol. 2021; 64 (2): 369–372. http://doi.org/10.4103/IJPM.IJPM_374_20

48. Cooke S.A. Misleading features in the clinical diagnosis of the peripheral glomus tumour. Br. J. Surg. 1971; 58 (8): 602–606. http://doi.org/10.1002/bjs.1800580817

49. Varian J.P., Cleak D.K. Glomus tumours in the hand. Hand. 1980; 12 (3): 293–299. http://doi.org/10.1016/s0072-968x(80)80056-8

50. Lopes T.D., Rotman M.B., Levy B.K., Gilula L.A. A 63-yearold woman with right small finger pain. Am. J. Orthop. (Belle Mead NJ). 1997; 26 (2): 169–171.

51. Van Geertruyden J., Lorea P., Goldschmidt D. et al. Glomus tumours of the hand. A retrospective study of 51 cases. J. Hand Surg. Br. 1996; 21 (2): 257–260.

52. Vasisht B., Watson H.K., Joseph E., Lionelli G.T. Digital glomus tumors: a 29-year experience with a lateral subperiosteal approach. Plast. Reconstr. Surg. 2004; 114 (6): 1486–1489. http://doi.org/10.1097/01.prs.0000138752.36175.d5

53. Carroll R.E., Berman A.T. Glomus tumors of the hand: review of the literature and report on twenty-eight cases. J. Bone Jt Surg. Am. 1972; 54 (4): 691–703.

54. Rettig A.C., Strickland J.W. Glomus tumor of the digits. J. Hand Surg. Am. 1977; 2 (4): 261–265. http://doi.org/10.1016/s0363-5023(77)80121-4

55. Mansat M., Bonnevialle P., Gay R., Durroux R. Tumeurs glomiques de la main: A propos de quatorze cas. [Glomus tumors of the hand: Presentation of fourteen cases]. Ann. Chir. de la Main. 1985; 4 (1): 43–50. http://doi.org/10.1016/S0753-9053(85)80081-8

56. Gandon F., Legaillard P., Brueton R. et al. Forty-eight glomus tumours of the hand. Retrospective study and four-year follow-up. Ann. Chir. Main. Memb. Super. 1992; 11 (5): 401–405. http://doi.org/10.1016/s0753-9053(05)80277-7

57. Arkwright S., Bachar M., Vilde F. Tumeurs glomiques. Etude clinique, histologique et immunohistochimique. A propos de vingt-neuf cas [Glomus tumors. Clinical, histological and immunohistochemical study. Apropos of 29 cases]. Arch. Anat. Cytol. Pathol. 1996; 44 (4): 160–165.

58. Kim S.-H., Suh H.-S., Choi J.-H. et al. Glomus Tumor: a Clinical and Histopathologic Analysis of 17 Cases. Ann. Dermatol. 2000; 12 (2): 95. http://doi.org/10.5021/ad.2000.12.2.95

59. Assmus H., Dombert T. Zur Lokalisation und operativen Behandlung der Glomustumoren der Extremitäten. Bericht über 36 Fälle [Glomus tumours of the extremities: localisation and operative treatment in 36 cases]. Handchir. Mikrochir. Plast. Chir. 2002; 34 (2): 103–107. German. http://doi.org/10.1055/s-2002-32308

60. Schiefer T.K., Parker W.L., Anakwenze O.A. et al. Extradigital glomus tumors: a 20-year experience. Mayo Clin. Proc. 2006; 81 (10): 1337–1344. http://doi.org/10.4065/81.10.1337

61. Frikh R., Alioua Z., Harket A. et al. Tumeurs glomiques: étude anatomoclinique de 14 cas avec revue de littérature [Glomus tumors: anatomoclinical study of 14 cases with literature review]. Ann. Chir. Plast. Esthet. 2009; 54 (1): 51–56. http://doi.org/10.1016/j.anplas.2008.05.001 (In French)

62. Lee D.W., Yang J.H., Chang S. et al. Clinical and pathological characteristics of extradigital and digital glomus tumours: a retrospective comparative study. J. Eur. Acad. Dermatol. Venereol. 2011; 25 (12): 1392–1397. http://doi.org/10.1111/j.1468-3083.2011.03979.x

63. Fazwi R., Chandran P.A., Ahmad T.S. Glomus tumour: a retrospective review of 15 years experience in a single institution. Malays. Orthop. J. 2011; 5 (3): 8–12. http://doi.org/10.5704/MOJ.1111.007

64. Kumar S., Tiwary S.K., More R. et al. Digital glomus tumor: An experience of 57 cases over 20 years. J. Family Med. Prim. Care. 2020; 9 (7): 3514–3517. http://doi.org/10.4103/jfmpc.jfmpc_446_20

65. Mashalkar N.S., Shetty N., Ellur S.R. Role of High Magnification Using Operative Microscope in Surgical Clearance of Glomus Tumor in Distal Phalanx: An Experience of 13 Cases. J. Cutan. Aesthet. Surg. 2022; 15 (3): 226–229. http://doi.org/10.4103/JCAS.JCAS_161_21

66. Deng M., Luo R., Huang J. et al. Clinicopathologic features of gastric glomus tumor: A report of 15 cases and literature review. Pathol. Oncol. Res. 2023; 28: 1610824. http://doi.org/10.3389/pore.2022.1610824

67. Anikin I.A., Komarov M.V. Glomus tumor (paraganglioma) of the ear. The current state of the problem. Literature review. Russian Otorhinolaryngology. 2010; 4 (47): 100–114. (In Russian)

68. Svistushkin V.M., Shevchik E.A., Mukhamedov I.T., Pshonkina D.M. Experience in surgical treatment of glomus tumors. Bulletin of Otrinolaryngology. 2017; 1: 15–19. http://doi.org/10.17116/otorino201782115-19 (In Russian)

69. Fan Z., Wu G., Ji B. et al. Color Doppler ultrasound morphology of glomus tumors of the extremities. SpringerPlus. 2016; 5: 1319. http://doi.org/10.1186/s40064-016-2883-0

70. Glazebrook K.N., Laundre B.J., Schiefer T.K., Inwards C.Y. Imaging features of glomus tumors. Skeletal Radiol. 2011; 40 (7): 855–862. http://doi.org/10.1007/s00256-010-1067-1

71. Lazor J.W., Guzzo T.J., Bing Z. et al. Glomus Tumor of the Kidney: A Case Report with CT, MRI, and Histopathological Findings. Open J. Urol. 2016; 6 (5): 80–85. http://doi.org/10.4236/oju.2016.65015

72. Tan T.J., Hayes M.M., Radigan J.P., Munk P.L. Glomus tumour of the colon: dynamic contrast-enhanced CT findings and review of the literature. Clin. Imaging. 2015; 39 (4): 714–716. http://doi.org/10.1016/j.clinimag.2015.02.015

73. Leger M., Patel U., Mandal R. et al. Glomangioma. Dermatol. Online. J. 2010; 16 (11): 11.

74. Ghaly R.F., Ring A.M. Supraclavicular glomus tumor, 20 year history of undiagnosed shoulder pain: a case report. Pain. 1999; 83 (2): 379–382. http://doi.org/10.1016/s0304-3959(99)00094-9