Glomus tumors of the hand Typical form and unusual aspects
Seance of wednesday 20 november 2024 (Communications libres)
DOI number : 10.26299/wth9-7b08/emem.2024.31.04
Abstract
First clinically described by Wood in 1812 then histologically by Masson in 1924, the glomus tumor or glomangioma is a rare but benign condition that mainly affects the hand.
Based on his surgical experience over 120 cases operated in 30 years, the author sheds light on this relatively unknown pathology, except among the sphere of hand surgeons and certain dermatologists:
- Short briefing on the typical subungual or pulp digital form and its three pathognomonic symptoms: spontaneous sharp or even syncope-inducing pain; touch-induced tenderness detected by Love’s pin test; intolerance to cold.
- Contribution and indications of the MRI-angiography developed for the hand since the 80s and supplanting other paraclinical tests (radiology, scintigraphy, arteriography and even Doppler-ultrasound);
- Documented description of certain présentations :
- misleading: psychiatric, canal-like (misdiagnosis or associated with carpal tunnel syndrome, ulnar nerve compression or cervical radiculopathy), ungual dystrophy
- atypical or unusual presentation: giant glomus tumor, location on the palm or back of the wrist, multiple tumors of the hand or on a single finger, painless glomangioma
- recurrent form
Treatment of a glomus tumours is exclusively surgical. The operation is performed under magnification, showing a well-defined nodule, often smaller under tourniquet than initially suggested by MRI. This surgery requires adhering to certain principles:
- identifying and marking the trigger -zone before regional anesthesia
- respecting the nail and its matrix
- monobloc excision of the lesion through a lateral or transungual approach
- systematically sending the specimen for histological examination, especially when there is intraoperative doubt about an atypical aspect of the lesion
By restauring a normal morphology and aspect of the finger and its nail, these precautions should allow the rapid disappearance of preoperative painful symptoms. This also helps limit the risk of a potential recurrence, which makes iterative excision more challenging.
Based on his surgical experience over 120 cases operated in 30 years, the author sheds light on this relatively unknown pathology, except among the sphere of hand surgeons and certain dermatologists:
- Short briefing on the typical subungual or pulp digital form and its three pathognomonic symptoms: spontaneous sharp or even syncope-inducing pain; touch-induced tenderness detected by Love’s pin test; intolerance to cold.
- Contribution and indications of the MRI-angiography developed for the hand since the 80s and supplanting other paraclinical tests (radiology, scintigraphy, arteriography and even Doppler-ultrasound);
- Documented description of certain présentations :
- misleading: psychiatric, canal-like (misdiagnosis or associated with carpal tunnel syndrome, ulnar nerve compression or cervical radiculopathy), ungual dystrophy
- atypical or unusual presentation: giant glomus tumor, location on the palm or back of the wrist, multiple tumors of the hand or on a single finger, painless glomangioma
- recurrent form
Treatment of a glomus tumours is exclusively surgical. The operation is performed under magnification, showing a well-defined nodule, often smaller under tourniquet than initially suggested by MRI. This surgery requires adhering to certain principles:
- identifying and marking the trigger -zone before regional anesthesia
- respecting the nail and its matrix
- monobloc excision of the lesion through a lateral or transungual approach
- systematically sending the specimen for histological examination, especially when there is intraoperative doubt about an atypical aspect of the lesion
By restauring a normal morphology and aspect of the finger and its nail, these precautions should allow the rapid disappearance of preoperative painful symptoms. This also helps limit the risk of a potential recurrence, which makes iterative excision more challenging.