Glomus Tumor Causing Knee Pain
- Affiliations
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- 1Department of Orthopaedic Surgery, Dankook University Medical College, Cheonan, Korea. lovebio1ogy@naver.com
- KMID: 2384559
- DOI: http://doi.org/10.4055/jkoa.2017.52.3.279
Abstract
- Glomus tumor is a kind of hemangioma that occurs at the glomerulus in the subcutaneous layer. It mainly occurs at the distal hand and subungual area, and rarely at the knee joint. Pain, tenderness, and cold intolerance are known symptoms; however, symptoms in practice are not so easily detectable, and the diagnosis can be delayed if it is presented at areas other than the hand. If the diagnosis is delayed, patients could suffer extreme pain. Therefore, early diagnosis and surgical treatment are important. Ultrasound and magnetic resonance imaging were used to diagnose glomus tumor in our cases, which were found in subcutaneous tissue and muscle fascia. We claim that, for patients with persistent pain, known symptoms"”extreme pain, cold intolerance, and tenderness"”should be examined carefully and rule out glomus tumor. We report 2 cases of glomus tumors around the knee joint, which is not a common location of occurrence.
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Figure
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Figure 1 Preoperative clinical photo showing the elevated subcutaneous layer of patellar tendon due to the bluish tender lesion on the left knee (arrowhead).
Figure 2 Ultrasound finding of the mass lesion. (A) Well-defined ovoid hypoechoic nodular lesion with a size of about 0.4×0.2×0.5 cm in the subcutaneous fat layer of the prepatellar area on transverse sonograms (arrow). (B) Hypervascular mass lesion on longitudinal Doppler sonograms.
Figure 3 Microscopic findings of the mass lesion. (A) It is composed of capillary sized vessels surrounded by solid proliferation of round-to-cuboidal epithelioid cells with round nuclei (H&E, ×200). (B) Tumor cells are smooth muscle actin (SMA) positive (SMA, ×200).
Figure 4 Sagittal T2 (A) and axial T1 (B) magnetic resonance imaging findings. Well-defined 1-cm-sized T1 iso signal (black arrowhead), T2 heterogeneous high signal nodular lesion (white arrowhead) in just the medial and deep aspects of the popliteal artery at the level of femoral insertion site of medial head of gastrocnemius tendon. Separated from neurovascular bundle in popliteal fossa.
Figure 5 Gross photo of specimen shows a round-in-shape, well-encapsulated mass with a size of 1.3×1.5×1.5 cm.
Figure 6 Microscopic findings. (A) Regular round tumor cells forming solid sheets showed central nuclei, small nucleoli, and conspicuous cytoplasmic borders (H&E, ×400). (B) Tumor cells are smooth muscle actin (SMA) positive (SMA, ×200).
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