Pathohistologic examination after resection revealed a benign glomus tumor.
A patient presented to the surgeon with a peculiar, painful swelling at the top of the fourth digit of the left hand. There was no history of trauma or infection. On physical examination, local soft tissue tenderness and thickening were apparent. A painful, partially mobile mass, located at the base of the nail of the fourth digit of the left hand was palpable.
On lateral radiograph of the fourth digit of the left hand, an obvious thinning of the dorsal cortical bone at the tip of the distal phalanx is seen (arrow).
MRI of the fourth digit of the left hand included sagittal SE T1-weighted image, sagittal SE T2-weighted image, axial SE T1-weighted image and Gd-enhanced axial SE T1-weighted image.
The sagittal and axial MR images demonstrate a small ovoid soft-tissue mass located at the posterior border of the distal phalanx. The mass is isointense with muscle on T1-weighted images and hyperintense on T2-weighted images. There is a marked enhancement after Gadolinium administration. Note also the erosion of the dorsal cortical bone.
Pathohistologic examination after resection revealed a benign glomus tumor.
Glomus tumor of the hand is a benign tumor developing from the neuromyoarterial apparatus, which regulates the skin perfusion. The tumor is frequently encountered in the soft tissue of the hands, especially at the tips of the first to fourth finger and less often in the fifth finger or the toes. A usual location of this tumor is the reticular dermis of the nailbed, less often in the lateral fold. Glomus tumors can occur in patients of any age, particularly those in the fourth and fifth decades of life. The ratio of male to female patients is not known.
Soft tissue glomus tumors with secondary osseous involvement are characteristically located in the distal phalanx of the hand. Occasionally the proximal and middle phalanx can be involved. Presence of multiple glomus tumors occurring in one digit has been described.
On conventional films, the tumor produces thinning or well marginated erosions of the adjacent bone, usually at the terminal phalanx. Sometimes, a sclerotic margin may be present surrounding the erosion. Because the lesion is richly vascularized, it shows a marked contrast enhancement on MR images after intravenous injection of Gadolinium. The differential diagnosis includes epithelial inclusion cyst, hemangioma and mucoid cyst. The latter shows similar MR characteristics as glomus tumor, but does not enhance after contrast injection.
Benign glomus tumor
Based on the provided X-ray and non-contrast/contrast-enhanced MRI images, the main findings are as follows:
1. The X-ray of the distal phalanx of the index finger shows an area of irregular bone morphology or mild bone destruction with relatively clear boundaries, potentially accompanied by local cortical thinning or localized erosion.
2. On MRI sequences, the lesion appears isointense or slightly hypointense on T1WI, and hyperintense on T2WI or FS sequences.
3. After contrast enhancement, the lesion demonstrates significant enhancement, suggesting a richly vascularized lesion.
4. The lesion is localized in the soft tissue, causing mild changes to the adjacent distal phalanx of the finger, with relatively clear margins.
Combining the patient’s clinical presentation (finger pain, local tenderness, sensitivity to cold stimuli, etc.) and the imaging findings, the possible diagnoses include:
1. Epithelial Inclusion Cyst: Often located at the fingertip, but typically shows weak or no significant enhancement on MRI.
2. Hemangioma: Richly vascularized and can also show marked enhancement on MRI, but it is more commonly found in the subcutaneous layer or muscle layer, and less frequently involves the phalanges.
3. Mucoid Cyst: May also occur at the fingertip with high signal on T2WI, but generally does not present with remarkable enhancement post-contrast.
Taking into account the patient’s age, clinical symptoms, surgical and pathological findings (benign pheochromocytoma-like structure, classified under Glomus tumor), and the characteristic strong enhancement on MRI, the most likely and confirmed diagnosis is: Benign “finger (nail bed) glomus tumor”.
Treatment Strategy:
1. Surgical Treatment: For a confirmed finger (nail bed) glomus tumor, surgical excision is the primary and effective treatment. Complete excision should be ensured intraoperatively to prevent recurrence.
2. Conservative/Medication Therapy: Since surgical removal is the mainstay of treatment, conservative therapies have limited efficacy and are mostly used for postoperative pain management or in cases where surgery must be temporarily postponed for other reasons.
Rehabilitation and Exercise Prescription:
• Early Postoperative Period (1–2 weeks): Focus on local wound healing and pain management, avoiding excessive load or forceful traction on the affected finger. Gentle active flexion-extension exercises of the finger can be performed, with short duration (1–2 minutes) and low frequency (2–3 times per day) to minimize postoperative adhesions.
• Mid Postoperative Period (2–4 weeks): Upon good wound healing, gradually increase the range of motion exercises of the finger. Simple actions such as gentle fist making and extension in warm water can be done 2–3 times per day, 3–5 minutes each time.
• Late Postoperative Period (after 4 weeks): Introduce moderate resistance exercises (e.g., squeezing a soft rubber ball or using a light hand gripper). Pay attention to intensity and frequency, avoiding excessive fatigue that might trigger a recurrence of pain. Depending on individual joint mobility and pain tolerance, each session could last 3–5 minutes, 2–3 times a day, with gradual increases in frequency or duration if there is no discomfort.
• Personalization and Safety Considerations: If the patient has other comorbidities (e.g., osteoporosis, arthritis), exercise intensity should be cautiously escalated under specialist guidance to ensure safety.
Disclaimer: This report is formulated based on the provided medical history and imaging data and is intended for reference only. It cannot replace an in-person consultation or professional medical advice. If you have questions, please consult a specialist and consider the overall clinical context.
Benign glomus tumor
