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Extradigital Glomus Tumors of the Upper Extremity: Systematic Review of Atypical Tumor Presentations Proximal to the Hand
Elad Fraiman BS, Vikas S. Kotha, M.D., Grzegorz J. Kwiecien, M.D
Cleveland Clinic Foundation
2024-02-01
Presenter: Vikas Kotha, MD
Affidavit:
100% original work of the resident
Director Name: Raymond Isakov
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Introduction:
Glomus tumors, rare neoplasms found primarily in digits, present diagnostic challenges when occurring in extradigital locations. This often leads to misdiagnoses and delayed treatment. Characterized by symptoms like pinpoint pain and cold sensitivity, they mimic other vascular or neural pathologies. This study aims to elucidate the epidemiology and diagnostic challenge of extradigital glomus tumors.
Methodology:
A systematic review was conducted using PubMed and Google Scholar, focusing on literature up to April 1, 2023. 37 English-language studies were included, primarily case reports and retrospective reviews.
Results:
Total sample size 136. Average symptom duration before diagnosis was nearly 72 months. The most common tumor location was forearm (n=39, 28.6%) and lower extremity (n=28, 20.5%). The studies revealed a high rate of misdiagnosis, between 48% and 84%. Presenting symptoms were consistent with classic digital glomus tumors, with pinpoint tenderness (86%) and pain (70%). Additional symptoms like painful swelling, hand clumsiness, and night-time pain were reported. Diagnostic imaging varied; MRI was the most common modality. Immunoreactivity studies predominantly showed SMA positivity (81.25%).
Conclusion:
Extradigital glomus tumors are more prevalent than typically recognized and pose significant likelihood of misdiagnosis. This misidentification often leads to prolonged symptomology. Imaging frequently falls short in specific diagnosis, highlighting the importance of clinical suspicion. This study underscores the need for greater awareness of likelihood of extradigital glomus tumors.
