The Diagnosis and Treatment of Glomus Tumor

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IN the Edinburgh Medical Journal of 1812, Wood1 described a small, bluish, benign, subcutaneous nodule associated with severe paroxysmal pain and tenderness. He called this lesion a “painful subcutaneous tubercle.” In 1878, Kolaczek2 described the subungual location of a painful tubercle, which he believed to be a variant of angiosarcoma. We are indebted to Barré3 and to Masson4 for the correct interpretation of the pathologic anatomy of this painful tubercle. They called it a glomus tumor because of its relationship to the normal neuromyoarterial glomus.

The diagnosis of glomus tumor is frequently overlooked or missed because of the physician’s lack of familiarity with the lesion. Glomus tumor should be considered in the differential diagnosis of any acutely painful subcutaneous or subungual lesion.

The glomus is a normal structure in the stratum reticulare corii and seldom is more than 1 mm. in diameter. The glomus is a specialized anastomotic mechanism connecting a terminal arteriole with a primary venule. The efferent arteriole branches into a tortuous anastomotic vessel that has an endothelial lining and two ill-defined muscular layers. Situated among the muscle cells are clear epithelioid cells having oval or globular nuclei—the so-called glomal cells (Fig. 1); these cells are thought to be closely related to the pericytes, which normally are scattered at intervals over the outer surface of capillaries. The glomus is surrounded by a fibrous capsule and is richly supplied with sympathetic nerve fibrils. The function of the normal glomus is most likely that of temperature regulation of the. . .



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