Journal of Cytology
Home About us Ahead of print Instructions Submission Subscribe Advertise Contact e-Alerts Login 
Users Online:14
  Print this page  Email this page Small font sizeDefault font sizeIncrease font size


 
CASE REPORT Table of Contents   
Year : 2010  |  Volume : 27  |  Issue : 3  |  Page : 104-105
Cytodiagnosis of glomus tumor


Department of Pathology, Bankura Sammilani Medical College, West Bengal, India

Click here for correspondence address and email

Date of Web Publication21-Oct-2010
 

   Abstract 

Glomus tumors are uncommon, with an estimated incidence of 1.6%. Cytological descriptions of this tumor are few. We report a 15-year-old boy presenting with a painful subungual swelling. Fine needle aspiration cytology showed uniform cells with homogeneous chromatin and scanty cytoplasm. Cytology was reported as "suggestive of glomus tumor". Histopathological examination confirmed the diagnosis. Careful cytomorphological examination supported by appropriate clinical history should suggest the diagnosis of glomus tumor and help in preoperative diagnosis.

Keywords: Fine needle aspiration cytology; glomus tumor; subungal.

How to cite this article:
Mukherjee S, Bandyopadhyay G, Saha S, Choudhuri M. Cytodiagnosis of glomus tumor. J Cytol 2010;27:104-5

How to cite this URL:
Mukherjee S, Bandyopadhyay G, Saha S, Choudhuri M. Cytodiagnosis of glomus tumor. J Cytol [serial online] 2010 [cited 2014 Oct 1];27:104-5. Available from: http://www.jcytol.org/text.asp?2010/27/3/104/71876



   Introduction Top


Glomus tumor is a distinctive neoplasm, the cells of which resemble the modified smooth muscle cells of the normal glomus body. The normal glomus body is a specialized form of arteriovenous anastomosis that serves in thermal regulation. It is located in the stratum reticularis of the dermis and is most frequently encountered in the subungual region, the lateral areas of the digits and the palm. The tumors are uncommon, with an estimated incidence of 1.6%. [1] We present a case of a 15-year-old boy with a glomus tumor in the subungual region diagnosed by cytology. As the tumors occur rarely, cytomorphological descriptions are few. [2],[3],[4]


   Case History Top


A 15-year-old boy presented with a painful swelling in the subungual region of the right index finger, about 1.5 cm in diameter. Radiographs demonstrated a soft tissue lesion with no bony involvement. Fine needle aspiration cytology of the swelling was performed.

Smears exhibited groups of cohesive, uniform, small, round to polygonal cells with scanty cytoplasm, indistinct cell borders and round nucleus with homogeneous chromatin. In few cell clusters, very scanty, wispy intercellular myxoid material was seen. Occasional capillaries were seen crossing cell clusters. Cytology was reported as "suggestive of glomus tumor" [Figure 1].
Figure 1 :Round to oval cells with homogenous granular chromatin, scanty cytoplasm and indistinct cell borders. A capillary crossing a cell cluster (MGG, ×400)

Click here to view


Surgical excision was followed by histopathological examination. Histologically, the lesion was well circumscribed, consisting of capillary- sized vessels surrounded by collars of glomus cells with a rounded, regular shape and a punched-out regular nucleus set off from the amphophilic cytoplasm. The outlines of the cells were not well defined. Reticulin stain confirmed the morphology of glomus. A histopathological diagnosis of glomus tumor was made.


   Discussion Top


The first cytological description of glomus was given by Holck et al. [4] in an axillary mass misdiagnosed as ectopic breast tissue.

Glomus tumors cause little diagnostic difficulty at histopathology, especially if the clinical presentation is typical. However, glomus can also occur in the gastrointestinal tract, solid organs (liver, kidney) and the extremities. [5] There is a recent report of a glomus in the stomach diagnosed by endoscopic ultrasound-guided fine needle aspiration cytology. [3] Cytomorphological characterization of a classical case of glomus tumor can help in cytological diagnosis at uncommon sites. Cytomorphologic features have been poorly defined. Reports have described cohesive clusters of uniform round cells with scanty cytoplasm, similar to the present case. [3],[6],[7] Gu et al. [7] have described a background of scattered amorphous material similar to the wispy magenta material in our case. Debol et al. [3] have described a background with vascular channels and Vinette-Leduc et al. [6] have found a background of blood, bare nuclei and occasional inflammatory cells.

One of the difficulties at aspiration could be a hemorrhagic aspirate. Paucicellularity was reported by some authors. [3],[7] The authors suggest needling of the tumor without aspiration. The differential diagnoses are many. Eccrine spiradenoma may present a difficult diagnostic problem. [8] However, the localization of glomus cells around blood vessels and lack of acini formations are helpful features. [9] Smears of eccrine spiradenoma show the presence of bland uniform cells in cohesive clusters and cribriform sheets with rosette-like structures surrounding the amorphous material. Cytologic distinction rests on identifying three types of cells - larger epithelial cells, myoepithellial cells and smaller lymphocytes. [8] Glomus tumors have to be differentiated from other vascular lesions, such as hemangiopericytoma, paraganglioma and lobular hemangioma, depending on the site of origin of the tumor. In hemangiopericytoma, cellular smears show knobby clusters of oval to spindle-shaped cells with ill-defined, finely granular cytoplasm and bland nuclei, but the number of mitotic figures varies. In paragangliomas, cells may show moderate nuclear pleomorphism with fine red granules in the cytoplasm. Lobular capillary hemangioma show clusters of oval to spindle-shaped cells along with a cellular infiltrate of neutrophils and mononuclear cells. [2] Because glomus tumor is derived from pericytes with special modification toward glomus cells, it is closely related to myopericytoma and myofibroma. In general, the glomus tumor consists of more rounded cells related to blood vessels whereas the other two lesions tend to have larger, less-rounded cells with more cytoplasm and ill-defined cell borders. However, glomus tumor with spindle cell morphology might exhibit overlapping cytologic features. [10] Tumors located in the gastrointestinal tract should be differentiated from gastrointestinal stromal tumors. For all differential diagnoses, careful examination of cytological features described, like characteristic chromatin, indistinct cytoplasmic borders and presence of few vessels, should be helpful.

Accurate clinical history and cytology can diagnose glomus tumors in most cases.

 
   References Top

1.Perivascular tumors. In: Weiss SW, Goldblum JR, editors. Enzinger and Weiss's soft tissue tumors. 4 th ed. Mosby; 2001. p. 985.  Back to cited text no. 1      
2.Handa U, Palta A, Mohan H, Punia RP. Aspiration cytology of glomus tumor: a case report. Acta Cytol 2001;45:1073-6.  Back to cited text no. 2  [PUBMED]    
3.Debol SM, Stanley MW, Mallery S, Sawinski E, Bardales RH. Glomus tumor of the stomach: cytologic diagnosis by endoscopic ultrasound-guided fine-needle aspiration. Diagn Cytopathol 2003;28:316-21.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Holck S, Bredesen JL. Solid glomus tumor presenting as an axillary mass: report of a case with morphologic study, including cytologic characteristics. Acta Cytol 1996;40:555-62.  Back to cited text no. 4  [PUBMED]    
5.Matevossian E, Brücher B LDM, Nährig J, Feubner H, Hüser N. Glomus tumor of the stomach simulating a gastrointestinal stromal tumor: a case report and review of literature. Case Rep Gastroenterol 2008;2:1-5.  Back to cited text no. 5      
6.Vinette-Leduc D, Yazdi HM. Fine-needle aspiration biopsy of a glomus tumor of the stomach. Diagn Cytopathol 2001;24:340-2.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.Gu M, Nguyen PT, Cao S, Lin F. Diagnosis of gastric glomus tumor by endoscopic ultrasound-guided fine needle aspiration biopsy. A case report with cytologic, histologic, and immunohistochemical studies. Acta Cytol 2002;46:560-6.  Back to cited text no. 7  [PUBMED]    
8.Vidyavathi K, Udayakumar M, Prasad CS, Kumar HM. Glomus tumor mimicking eccrine spiradenoma on fine needle aspiration. J Cytol 2009;26:46-8.  Back to cited text no. 8    Medknow Journal  
9.Haupt HM, Stern JB, Berlin SJ. Immunohistochemistry in the differential diagnosis of nodular hidradenoma and glomus tumor. Am J Dermatopathol 1992;14:310-4.  Back to cited text no. 9      
10.Gombos Z, Zhang JF. Glomus tumor. Arch Pathol Lab Med 2008;132:1448-52.  Back to cited text no. 10      

Top
Correspondence Address:
Sumana Mukherjee
BH-62, Sector-2, Salt Lake, Kolkata - 700 091
India
Login to access the Email id


DOI: 10.4103/0970-9371.71876

PMID: 21187877

Get Permissions



    Figures

  [Figure 1]

This article has been cited by
1 A rare case of a calcified glomus tumour in the thigh of an adolescent
Dabadie, A. and Fernandez, C. and Gorincour, G. and Panuel, M. and Petit, P.
Pediatric Radiology. 2013; 43(8): 1045-1048
[Pubmed]
2 A rare case of a calcified glomus tumour in the thigh of an adolescent
Alexia Dabadie,Carla Fernandez,Guillaume Gorincour,Michel Panuel,Philippe Petit
Pediatric Radiology. 2013; 43(8): 1045
[Pubmed]



 

Top
 
  Search
 
  
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Case History
    Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed1416    
    Printed81    
    Emailed0    
    PDF Downloaded84    
    Comments [Add]    
    Cited by others 2    

Recommend this journal