Summary: A 42-year-old female presents with a fifth digit fingertip
that is sensitive to touch.
Diagnosis
Glomus tumor
Findings
Plain radiographs of the fifth digit demonstrate smooth scalloping of the dorsal aspect
of the fifth digit distal phalanx. The soft tissue mass is not evident on the
plain radiographs. Sagittal STIR and axial T1 precontrast and postcontrast with
fat saturation demonstrate a well-defined soft tissue lesion, which is markedly
hyperintense on STIR images. The lesion is isointense to skeletal muscle on
T1-weighted images and demonstrates avid homogenous enhancement
Discussion
Glomus tumors are mesenchymal tumors arising from the
neuromyoarterial plexus. It may occur anywhere throughout the body, but is most
common in the subungual region of fingers and toes. Glomus tumors may be found
in patients of any age, but are most common in adults between the ages of 30
and 50. Patients present with sensitivity to touch and cold temperature. The vast
majority of glomus tumors are benign with <1% found to be malignant. Three
subcategories of glomus tumors have been described, including solid glomus
tumors as in this case, which account for 75% of glomus tumors. Approximately 20% are glomuvenous malformations,
which are less circumscribed and are similar in appearance to cavernous
hemangiomas, and <5% are glomangiomyomas.
Plain radiographs of subungual glomus tumors demonstrate smooth scalloping of the
dorsal aspect of the distal phalanx at the location of the nailbed. The
scalloped cortex may demonstrate a sclerotic border. Magnetic resonanc imaging
findings include a well-defined, homogenous lesion, which is isointense to
muscle or the adjacent nail bed on T1-weighted images and hyperintense on T2-weighted
images. Post-contrast images demonstrate intense homogeneous enhancement.
Treatment consists of surgical excision with a local recurrence rate of approximately
10%.
- Drape JL, Idy-Peretti I, Goettmann S, et al. Subungual glomus tumors: Evaluation with MR imaging. Radiology. 1995;195:507-515.
- Theumann NH, Goettmann S, Le Viet D, et al. Recurrent glomus tumors of fingertips: MR imaging evaluation. Radiology. 2002;223:143-151.