Glomangiomas, also known as glomus tumours, are benign vascular tumours typically seen at the distal extremities. These tumours should not be confused with paragangliomas (sometimes referred to as glomus tumour).
It classically presents in young to middle aged (4th to 5th decades 7). There is a recognised female predilection. They can be multiple in ~ 10% of cases. Glomus tumors account for 1-5% of the soft-tissue tumors in the hand 4.
The lesion usually presents as a small firm red-blue nodule under the finger nail and is exquisitely painful. Sometimes the pain is worse at night; it may disappear when a tourniquet is applied.
May also present as haemorrhage under the nail. The presence of the Hildreth sign (pain following the application of a tourniquet proximally) is considered pathognomonic on clinical grounds 7.
Glomus tumours originate from the neuromyoarterial plexus: modified smooth muscle cells of the glomus body. They are best thought of as harmatomas rather than true tumours. There are two main components on microscopy:
- branching vascular channels
- aggregates of specialised glomus cells
Approximately 75% occur in the hand 4.
- the tumour is difficult if not impossible to identify - rarely can be seen as a subtle soft tissue density
- may show a marginated osseous erosion or thinning of the adjacent cortical bone
Signal characteristics include:
- T1: low to intermediate signal
- T1 C+(Gd): shows contrast enhancement (usually uniform) due to vascularity
- T2: high signal
- subungual hypoechoic lesion at the region of maximum tenderness
- hypervascularity on Doppler interrogation
Treatment and prognosis
Treatment is surgical resection.
General imaging differential considerations include:
- paraganglioma (also sometimes called glomus tumour)
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- 2. Drapé JL, Idy-peretti I, Goettmann S et-al. Subungual glomus tumors: evaluation with MR imaging. Radiology. 1995;195 (2): 507-15. Radiology (abstract) - Pubmed citation
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- 4. Van ruyssevelt CE, Vranckx P. Subungual glomus tumor: emphasis on MR angiography. AJR Am J Roentgenol. 2004;182 (1): 263-4. AJR Am J Roentgenol (full text) - Pubmed citation
- 5. Perks FJ, Beggs I, Lawson GM et-al. Juxtacortical glomus tumor of the distal femur adjacent to the popliteal fossa. AJR Am J Roentgenol. 2003;181 (6): 1590-2. AJR Am J Roentgenol (full text) - Pubmed citation
- 6. Theumann NH, Goettmann S, Le viet D et-al. Recurrent glomus tumors of fingertips: MR imaging evaluation. Radiology. 2002;223 (1): 143-51. doi:10.1148/radiol.2231010977 - Pubmed citation
- 7. Teh J, Whiteley G. MRI of soft tissue masses of the hand and wrist. Br J Radiol. 2007;80 (949): 47-63. doi:10.1259/bjr/53596176 - Pubmed citation