Multiple intraneural glomus tumors in different digital nerve fascicles
- 118 Downloads
Glomus tumors in the digital nerve are extremely rare. Multiple intraneural glomus tumors in different digital nerve fascicles have not been previously reported.
We report the case of a 54-year-old male with a 1-year history of progressive numbness of the middle finger with point tenderness at the level of the middle phalanx. Surgical incision revealed the presence of two glomus tumors within different fascicles of the ulnar digital nerve of the middle finger.
One tumor was excised along with surrounding fascicle, the other was removed leaving the fascicle intact. Subsequently, the patient regained function of the finger and no tumors have recurred.
Patients and physicians should be aware of the properties of intraneural glomus tumors so that early diagnosis and treatment can be sought.
KeywordsIntraneural glomus tumor Digital nerve Surgical resection
magnetic resonance imaging
Glomus tumors are rare benign neoplasms that most frequently occur in the subungual regions of digits. Glomus tumors originating within.
digital nerves are extremely rare. Previous studies have reported six cases of solitary intraneural glomus tumors [1, 2, 3, 4, 5, 6] and one case of multiple glomus tumor within one single swollen fascicle . This study describes two intraneural glomus tumors located in different fascicles of the same digital nerve. To our knowledge, no such case has previously been reported.
Discussion and conclusions
Glomus tumor is a rare benign tumor that most frequently occurs in the glomus body in the subungual regions of digits . The typically cell components were glomus cells, vasculature, and smooth muscle cells . Within the glomus tumor family, the glomus tumor itself consists predominantly of glomus cells. The glomangioma shows high density of vascularity  and the glomangiomyoma shows elongated smooth muscle cells in pathological manifestation . The clinical diagnosis of glomus tumor is made based on examination. Typical symptoms of a glomus tumor are localized pain and cold sensitivity . An intraneural glomus tumor of the digital nerve may cause numbness and tingling, cold insensitivity, paresthesia, a positive Tinel’s sign, or no neurological deficits [1, 2, 3, 4, 7]. Although the number of cases is small, it is evident that the symptoms of a glomus tumor are similar to those of a neuroma, and thus, it is difficult to make a definite diagnosis by physical examination alone. Because of the presence of numbness and a positive Tinel’s sign, the present case was initially diagnosed as a neuroma. Pacinian corpuscles neuroma was pain and swelling tumor in finger with or without history of trauma, subcutaneous plane, spherical, gray and in clusters lesions can be observed in pathological study . Giant cell tumor of tendon sheath is a common benign with incentives, multiple nodules tumor arising in the tendon sheath. In treatment, the elimination of the tumor lesions including soft tissue and bone is favored. Synovial cells and a few multinucleated giant cells can be observed in pathological study . Enchondroma was the most common benign tumour of the tubular bones in hands. The treatment was usually surgery .MRI is an effective tool to identify finger masses [14, 15]. In the present case, although MRI findings suggested that the tumor originated from the nerve, the significant increase in the signal after contrast enhancement was not consistent with the imaging features of a neuroma. However, the presence of multiple intraneural glomus tumors has not been previously reported; furthermore, the tumor may be too small. Thus, the intraoperative exploration must be thorough. A biopsy was not conducted in order to avoid bleeding owing to the proximity of the tumor to the proper palmar digital artery.
A surgical procedure was conducted to remove the tumor completely. Some intraneural glomus tumors cannot be detached from the nerve fascicle and can only be removed along with some segment of the nerve fascicle, which can cause nerve defects. The use of nerve grafts for treatment of digital nerve defects results in greater losses in the donor sites . If an intraneural glomus tumor is clinically suspected, a relevant examination, such as MRI, must be performed as early as possible to enable early diagnosis and save the nerve fascicle. In the present case, one nerve fascicle could be preserved, and thus, recovery of nerve function after surgery is expected to be ideal. The patient fully recovered sensation in his fingertip at 6 months after surgery. Intraneural glomus tumor must be added to the differential diagnosis of neurogenic tumors. Early diagnosis can enable the retention of neurological function.
HL designed the study, performed data collection, analyzed the results, and YW drafted the manuscript. All the authors have read and approved the final manuscript.
The study was funded by the National Natural Science Foundation of China (the grant number 81702135), Zhejiang Traditional Chinese Medicine Research Program (grant number 2016ZA124, 2017ZB057) and Zhejiang Medicine and Hygiene Research Program (grant number 2016KYB101, 2015KYA100). The funding bodies had no role in the design of the study; in collection, analysis, and interpretation of data; and in drafting the manuscript.
Ethics approval and consent to participate
The study protocols were approved by the Medical Ethics Committee of the First Affiliated Hospital of the College of Medicine, Zhejiang University.
Consent for publication
Written informed consent was obtained from the patient for publication of clinical details and clinical images. Upon request, a copy of the consent form is available for review by the Editor of this journal.
The authors declare that they have no competing interests.
- 12.Masson P. Le glomus neuromyo-artériel des régions tactiles et ses tumeurs. Lyon Chir. 1924;20(21):256–80.Google Scholar
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.