CASE REPORT
Acta Orthop Traumatol Turc 2016;50(2):242–244
doi: 10.3944/AOTT.2015.13.0134
Glomus tumor located in deltoid muscle
Ozan BEYTEMÜR1, Oktay ADANIR1, Ümit Seza TETİKKURT2, Mehmet Akif GÜLEÇ1
BağcılarTraining and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey
2
BağcılarTraining and Research Hospital, Department of Pathology, İstanbul, Turkey
1
Glomus tumors are benign soft tissue neoplasms arising from the glomus body, which are primarily
found under the nail bed of the fingers. They are rarely located in other parts of the body. Only 8 cases
of glomus tumors around the shoulder have been published in the literature. The purpose of this study
was to present a glomus tumor located in the deltoid muscle in a 68-year-old male patient that was
surgically treated by marginal excision. The patient remained asymptomatic, and no recurrence was
detected at 2-year follow up.
Keywords: Glomus tumor; shoulder; surgical treatment.
Glomus tumors are benign soft tissue tumors arising
from glomus body.[1–13] They were first described by
Wood as a painful subcutaneous nodule in 1812, and a
pathological description was made by Masson in 1924.
[4,7]
Glomus tumors are most commonly found under
the nail bed of the fingers. Localizations other than the
hand are very rare.[1–10]
To date, there have been only 8 cases of glomus tumors described around the shoulder in the literature.[1]
The purpose of this study was to present this very rare
case of a glomus tumor localized around the shoulder.
Case report
A 68-year-old man with a 1-year history of painful swelling around the shoulder attended to our department. Different medical treatment modalities had previously been
applied, but his complaints persisted. During physical examination, he had a 2x3-cm swelling on the anterior part
of his left shoulder. The mass was sensitive and painful to
palpation. His complaints deteriorated with ice applica-
tion. Plain X-rays of the shoulder were normal. Contrast
magnetic resonance imagine (MRI) revealed a well-defined mass that was hypointense in T1-weighted images
and hyperintense in T2-weighted images, with a dimension of 2x3 cm, located inside the anterior fibers of the
left deltoid (Figure 1). Surgical treatment was planned because the lesion was symptomatic. The lesion was superficial, small, and well defined, and no reaction was observed
in soft tissues around the lesion; therefore, direct surgical
excision was planned without performing a prior biopsy.
Written informed consent was obtained from the patient.
Under general anesthesia, the patient was placed in
beach chair position, and a 4-cm longitudinal incision was
made over the lesion, which was excised marginally.
Microscopic examination revealed that the tumor was
well defined and possessed a complex vascular structure.
The vessels were surrounded by cell clusters containing eosinophilic cytoplasm. The nuclei of the cells were
round and small. Tumor cells represented widespread immunoreaction with vimentin and smooth muscle actin.
Correspondence: Ozan Beytemür, MD. Bağcılar Eğitim ve Araştırma Hastanesi,
Ortopedi ve Travmatoloji Kliniği, İstanbul, Turkey.
Tel: +90 212 – 440 40 00 e-mail: [email protected]
Submitted: November 17, 2013 Accepted: September 28, 2014
©2016 Turkish Association of Orthopaedics and Traumatology
Available online at
www.aott.org.tr
doi: 10.3944/AOTT.2015.13.0134
QR (Quick Response) Code
243
Beytemür et al. Glomus tumor located in deltoid muscle
(a)
Fig. 1.
(b)
(c)
Axial (a) and coronal (b, c) MRI images showing the lesion.
(a)
Fig. 2.
(b)
(a) Glomus tumor with cells containing rich granular eosinophilic cytoplasm, resembling oncocytes (hematoxylin and eosin stain x200).
(b) Tumor cells that represent widespread immunoreaction with smooth muscle actin (smooth muscle actin x100). [Color figures can be
viewed in the online issue, which is available at www.aott.org.tr]
Diagnosis was made as glomus tumor according to these
pathological findings (Figure 2a, b). The patient had no
complaints immediately following surgery and remained
asymptomatic during the 2-year follow-up period.
Discussion
Glomus tumors are benign soft tissue neoplasms arising
from glomus bodies located in the dermis. Glomus bodTable 1.
ies regulate body temperature by organizing skin blood
flow.[1,2,7,8]
Glomus tumors are most commonly seen in the
hand, especially under the nail bed. They may appear
anywhere on the body, but localization other than hand
is very rare. Localizations such as the forearm, triceps
tendon, in front of the patella, and shoulder region have
been described in the literature.[1,3,4,7,9] To date, there have
Glomus tumor cases around the shoulder described previously in the literature.
Author
Year
Anatomic localization
Gender Age
Karakurum G. et al.[1]
Boretto JG. et al.[2]
Gautam VK. et al.[13]
Solivetti FM. et al.[12]
Abela M. et al.[5]
Yoshikawa G. et al.[10]
Massey EW.[11]
2009
2008
2008
2002
2000
1996
1992
Posterior fibers of deltoid muscle
Insertion side of deltoid muscle to humerus Acromion Not attainable Scapular region- subcutaneous
Rotator cuff
Suprascapular region
Male Female Female
Male
Male
Female
Female
71
54
25
58
52
35
41
244
been 8 cases described around the shoulder region in the
literature (Table 1). There have been 2 cases described in
the literature around the deltoid muscle localization, 1 of
which was in the posterior fibers of deltoid muscle and
the other at the insertion of the deltoid muscle to the
humerus.[1,2] Ours is the second case localized intramuscularly around the deltoid muscle region.
A period of 10–20 years until diagnosis has been reported in the literature.[2,5] With this report, we want to
emphasize that glomus tumors should be considered in
the differential diagnosis for shoulder pathologies which
are commonly seen in orthopedic clinics.
The most important signs in the diagnosis of glomus
tumors are pain, cold intolerance, and sensitivity to pressure and touch.[1,2,7–9] There were complaints of pain and
sensitivity in our case, which lessened with cold application. It is easy to diagnose glomus tumors localized in the
hand because of their typical appearance, but diagnosing
glomus tumors in other localizations is very difficult. In
the differential diagnosis, pathologies such as neuroma,
rotator cuff pathologies, fat necrosis, and cystic lesions
must be considered.[2]
Plain X-ray is generally normal in patients with glomus tumors. The lesions can be seen with MRI, which
has a high sensitivity but low specificity.[2,6,7]
Conservative methods are usually inadequate in the
treatment of glomus tumors.[2,3,8] Most patients with
glomus tumors receive other forms of treatment prior to
undergoing surgery. In our case, the patient received previous medical treatment, but his complaints persisted.
Marginal excision is sufficient as a surgical procedure. Complaints from the patient commonly cease
immediately after surgery. Continuation of complaints
after surgery may signify inadequate surgical excision.
In our case, the patient had no complaints immediately
after surgery, and he remained asymptomatic during the
2-year follow-up period. Recurrence is very rare and
usually seen in cases of inadequate excision and when
there are multiple localizations of glomus tumors.[8]
Glomus tumors are most commonly seen in hands
but may be seen anywhere in the body. In the differential
diagnosis of a painful and sensitive swelling, glomus tu-
Acta Orthop Traumatol Turc
mor must be considered. MRI is useful in the diagnosis,
and marginal excision is adequate in the treatment.
Conflicts of Interest: No conflicts declared.
References
1. Karakurum G, Tutar E, Pirbudak L, Mizrak A. Glomus
tumour of the deltoid muscle. A case report. Acta Orthop
Belg 2009;75:681–3.
2. Boretto JG, Lazerges C, Coulet B, Baldet P, Chammas
M. Calcified glomus tumor of the shoulder. A case report.
Chir Main 2008;27:183–6. CrossRef
3. Heiney JP, Leeson MC. Unique size and location of a glomus tumor with a review of the literature. J Shoulder Elbow Surg 2009;18:1–3. CrossRef
4. Tomak Y, Dabak N, Ozcan H. Extradigital glomus tumor
of the triceps tendon as a cause of elbow pain: a case report. J Shoulder Elbow Surg 2003;12:401–2. CrossRef
5. Abela M, Cole AS, Hill GA, Carr AJ. Glomus tumor of
the scapular region. J Shoulder Elbow Surg 2000;9:532–3.
6. Ham KW, Yun IS, Tark KC. Glomus tumors: symptom
variations and magnetic resonance imaging for diagnosis.
Arch Plast Surg 2013;40:392–6. CrossRef
7. Lee S, Le H, Munk P, Malfair D, Lee ChH, Clarkson P.
Glomus tumour in the forearm: a case report and review
of MRI findings. JBR-BTR 2010;93:292–5. CrossRef
8. Ozdemir O, Coşkunol E, Ozalp T, Ozaksar K. Glomus
tumors of the finger: a report on 60 cases. Acta Orthop
Traumatol Turc 2003;37:244–8. [Abstract]
9. Akgün RC, Güler UÖ, Onay U. A glomus tumor anterior
to the patellar tendon: a case report. Acta Orthop Traumatol Turc 2010;44:250–3. CrossRef
10.Yoshikawa G, Murakami M, Ishizawa M, Matsumoto K,
Hukuda S. Glomus tumor of the musculotendinous junction of the rotator cuff. A case report. Clin Orthop Relat
Res 1996;326:250–3. CrossRef
11.Massey EW. Shoulder pain from glomus tumour. J Neurol
Neurosurg Psychiatry 1992;55:413–4. CrossRef
12.Solivetti FM, Thorel MF, Cota C, Donati P, Faloni E. Ultrasound pattern of glomus tumor of the shoulder. [Article in English, Italian] Radiol Med 2002;104:481–3.
[Abstract]
13.Gautam VK, Agarwal PK, Maini L, Prakash A. Intraosseous glomus tumor in acromion process of scapula. Orthopedics 2008;31:406. CrossRef