tumours are uncommon tumours which most commonly present in the
fingers, where extra-digital tumours are reported as rare
occurrences. Here we present a case of a glomus tumour of the
forearm and review the presentation with the modern radiological
appearances of these tumours. We present typical MRI images of
the tumour and discuss that extra-digital sites may not be as
rare as suspected.
glomus tumour; forearm; MRI
report the case of a 26 year old man who presented with a 12
month history of insidious onset, discreet lump of the forearm
which became increasingly painful, especially in the cold, but
did not increase in size. On examination, the lump seemed
superficial and was exquisitely tender to palpation. There was
no overlying erythema or any other signs of local change,
inflammation or invasion.
MRI scan was performed to assess the swelling and to assess
depth and invasion. Figures 1 and 2 show a 1cm diameter, well
circumscribed oval lesion contained to the subcutaneous tissues,
with no abnormality of the underlying muscle. It exhibited
homogenous enhancement with contrast which is classical of a
glomus tumour (figure 2).
patient underwent local excision of the lump where an
encapsulated hemangiomatous lump was removed. Subsequent
histology confirmed the diagnosis of a glomus tumour with
complete margins of excision. At review appointments, the
patient was completely symptom free.
1 and 2: a well circumscribed oval lesion is found in the
subcutenous lesions (marked as 9.2mm on figure 1). Upon
administration of contrast, the lesion enhances (figure 2).
tumours are benign neoplasia arising from arteriovenous
anastamoses found in the skin and subcutaneous skin of the
extremities, where they account for less than 5% of all hand
tumours. They are typically found subungally, that being on the
finger tip pulp. Symptomatically they have been classically
described as presenting with intermittent periods of pain, pain
to palpation and pain in cold conditions 1-3.
glomus tumours have been reported in many ‘extra-digital’
locations of the body, including most sites of the upper and
lower limbs, the visceral organs, the lungs and trachea and the
face and nose 1-9. Although it is recognised that they are
typically associated with the fingers and hands, our patient
adds to the literature of extra-digital locations.
ultrasound examination has been described as a traditional first
line investigation 10-12, more recently the advantages of MRI
scanning for these extra-digital tumours have replaced it 13-16.
The characteristic finding is a well-circumscribed lesion in the
subcutaneous tissues, which is enhancing on administration of
contrast 13-15, as in our patient’s case. MRI has the
advantages of assessing local and deep soft tissues for evidence
of invasion and other tumours, and so MRI scanning should be
considered the modern first line investigation of suspected
glomus tumours, both in the hand and extra-digitally. It can be
considered to be effective in identifying glomus tumours (sensitivity)
but not necessarily excluding them (specificity) 16.
of these tumours reveals an encapsulated lesion with no mitotic
activity. They contain an afferent arteriole and collecting
venule which are surrounded by rounded glomus cells. They may
contain smooth muscle and non-myelinated nerve endings.
terms of forearm tumours, pain in a well-circumscribed
subcutaneous lesion is the predominant feature 17-18 which
should arouse suspicion and prompt MRI scanning with subsequent
surgical excision. However, apt clinicians should consider the
differential diagnosis in such situations, which include
lipomas, neuroma, cysts and rarely soft tissue sarcomas. All
doctors should be familiar with the features of lumps suspicious
of malignancy: pain, deep seated lumps, size >5cm and rapid
growth 19. In contrast, glomus tumours of the forearm are often
<1cm in diameter, are superficial but are painful.
tumours are still predominately a tumour of the hand, although
they should be considered in the differential diagnosis of arm
lumps and may be more common in extra-digital locations than
suspected. The clinical presentation is often with pain, lesions
are typically less than 1cm in diameter and superficial, and
modern first line investigation is with MRI scanning. The
treatment is solely surgical excision, where the final diagnosis
is confirmed on histology.
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