alexa A Rare Case of Glomus Tumour on the Knee: Case Report and Literature Review

Journal of Dermatitis

Reach Us +1-947-333-4405
  • Review Article   
  • J Dermatitis 2018, Vol 3(1): 110

A Rare Case of Glomus Tumour on the Knee: Case Report and Literature Review

Natsuki Nakajima1, Takeshi Kozaru1, Takeshi Fukumoto2 and Masahiro Oka1*
1Division of Dermatology, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai 983-8512, Japan
2Division of Dermatology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
*Corresponding Author: Masahiro Oka, Division of Dermatology, Tohoku Medical and Pharmaceutical University, Sendai 983-8512, Japan, Tel: +81-22-259-1221, Fax: +81-22-259-1232, Email: [email protected]

Received Date: Jan 15, 2018 / Accepted Date: Jan 23, 2018 / Published Date: Jan 28, 2018

Abstract

We present a case of glomus tumour of the knee in an 82-year-old Japanese woman. The patient noticed a painful eruption on her right knee 6 years before our first examination. At first examination, a well-defined, subcutaneous, elastic, firm nodule 1 cm in diameter was present over the central portion of the patella. The lesion was easily surgically removed in block. On gross examination, the excised lesion was a well-defined smooth-surfaced mass measuring 8 mm × 6 mm × 5 mm. Histological and immunohistochemically findings for the nodule were consistent with the diagnosis of glomus Tumour. Pain was resolved immediately postoperatively. As of the last follow-up, 5 months postoperatively, the patient reported continued relief from pain. We summarized reported 29 cases of glomus Tumour of the knee, including the present case. Our summary revealed that glomus Tumours can develop in the knee in various anatomical sites, including the skin, deep adipose tissue, muscle, quadriceps tendon, and Hoffa's fat pad.

Keywords: Glomus tumour; Knee; Pain; Smooth muscle actin; Subcutaneous

Introduction

Glomus tumour is an uncommon benign hamartoma derived from the glomus body [1-4]. This Tumour is most often found in the skin, particularly the subungual region and palm, followed by the foot and forearm. However, glomus Tumour can occur within a wide anatomical distribution, including rarely in mucosa and internal organs [5,6]. We present herein a rare case of glomus Tumour on the knee skin, and review reported cases of glomus Tumour of the knee.

Case Report

An 82-year-old Japanese woman presented with a 6-year history of a tender, subcutaneous eruption on the right knee. Physical examination revealed a well-defined, subcutaneous, elastic, firm nodule 1 cm in diameter over the central portion of the patella (Figure 1a). The skin surface was slightly elevated, with a very slight purplish hue. The patient reported no history of injury to the knee. The lesion was easily surgically removed en bloc from the dermis under local anaesthesia. On gross examination, the excised lesion was a well-defined smooth- surfaced mass measuring 8 mm × 6 mm × 5 mm (Figure 1b). Around half of the mass was purplish-gray and the remaining portion was brownish. The resected specimen was examined histologically. The whole specimen was surrounded by a connective tissue capsule (Figures 1c and 1d). Half of the specimen was occupied with a markedly enlarged vascular lumen filled with erythrocytes (Figure 1c). The other half portion was composed of solid sheets of small, uniformly shaped cells with eosinophilic cytoplasm and round or ovoid nuclei (Figures 1d and 1e). Various sized blood vessels were distributed in the cell sheets. Immunohistochemical studies revealed that the small, uniformly shaped cells were positive for α-smoot muscle actin (SMA) (Figure 1f), and negative for desmin, epithelial membrane antigen (EMA), S-100, and AE1/AE3 (data not shown). Based on these clinical and histopathological findings, the cutaneous lesion 4 was diagnosed as a glomus Tumour. Pain was resolved immediately postoperatively. As of the last follow-up, 5 months postoperatively, the patient reported continued relief from pain.

dermatitis-Clinical-appearance

Figure 1: a, b) Clinical appearance of the skin lesion. A well-defined, intradermal, elastic, firm nodule of 1.0 cm in diameter over the central portion of patella (a). The skin surface is slightly elevated and shows a very slightly purplish hue (b). c-f) Histopathological findings for the excised nodule. The nodule is surrounded by connective tissue capsule (c, d). The half portion of the specimen is occupied with a markedly enlarged vascular lumen filled with erythrocytes (c). The other half portion is composed of solid sheets of small uniform cells with eosinophilic cytoplasm and round or ovoid nuclei, interspread with various-sized vascular channels (d, e). (c: hematoxylin and eosin, original magnification X20; d: hematoxylin and eosin, original magnification X100; e: hematoxylin and eosin, original magnification X200). By immunohistochemistry, the small uniform cells are immunoreactive for a-SMA (f) (original magnification X100).

Discussion

Including the present case, a total of 29 cases of glomus Tumour of the knee have been described in the English literature (Table 1).

Patient number Age, sex Location Size (method for measuring the size) Department in which patient was treated Imaging modality used for diagnosis Surface skin condition Pain (duration) Gross appearance of the excised specimen Histological finding Treatment and ioutcome Others Ref. (year)
1 69, F Medial and
lower border
of left patella
30 mm
(Physical
examination)
Rheumatology • Plain radiograph A warm, purplish swelling +(13 years) • A solid,well encapsulated tumor
3.6 cm in diameter
in the subcutaneous tissue
• Glomus tumor
• Glomus cells of varying size, which are uniform and intimately
connected with the numerous
vascular structures
Surgical resection
® Resolution of
the pain
No history of trauma (1966) [7]
2 54, M Right
popliteal
fossa
ND Orthopedic
surgery
ND ND +(ND) • Small nodule in
adipose tissue
Glomus tumor Surgical resection
® ND
Seven glomus tumors developed
between 24 to 54 years old in right popliteal fossa and right leg.
(1982) [1]
3 49, M Superpatellar
region of right
knee
10 mm
(Physical
examination)
Plastic and
reconstructive
surgery
None A boggy 1 cm
mobile mass
deep within
the subcutaneous
fat tissue
+(3 years) A 1 cm well-defined,
soft, oblong, pink
mass
• Glomangioma
• The tumor is composed of
large vascular sinusoids lined
by a monolayer of endothelial
cells beneath which there is a littoral arrangement of one to several layers of small, uniform,
round cells with pink,
occasionally vacuolated cytoplasm lying in a dense collagenous stroma.
• Positive immunostaining for vimentin and negative immunostaining for CEA, EMA,
S-100 and CAM5.2.
Surgical resection
® Resolution
of the pain
  (1993) [2]
4 52, M Behind left
knee
12 mm
(Physical
examination)
Dermatology None A cystic mobile
papule
- ND Glomus tumor (probably in the
subcutaneous tissue)
ND • No description on the histological
location of the tumor
• There was another glomus
tumor on the left thigh.
(1994) [8]
5 73, M Medial joint
line of right
knee
50 mm
(finding at
operation)
ND • Plain radiograph
• Arthroscopy
• MRI
A small, palpable,
exquisitely tender swelling
+(3 years) 5 cm grey/white, narrow tubular lesion
in the subcutaneous
tissue
Glomus tumor Surgical resection
® ND
• Decreased range of motion in the
knee(-)
• Medial joint line osteoarthritis
and chondrocalcinosis
(2002) [9]
6 54, M Lateral side
of left knee
5 mm
(MRI)
Orthopedic
surgery
• Plain radiograph
• MRI
ND +(3 years) A roundish, well-defined, smooth-surfaced, soft, pink mass, 7 × 6 × 4 mm in size, in the subcutaneous tissue • Glomus tumor
• Clumps of glomus cells varying
in size, intimately connected
with numerous vascular
structures
Surgical resection
® Resolution
of the pain
No history of trauma (2004) [10]
7 53, M Just below
medial joint
line of left
knee
20 ×15 mm
(MRI)
Orthopedic
surgery
• Plain radiograph
• MRI
A1 cm purple-colored,
soft, and
extremely tender
swelling
+(20 years) The tumor was
20 × 10 × 20 mm in size and was localized to the subcutaneous tissue surrounded by a brown connective
tissue capsule.
• Glomus tumor
• Positive immunostaining for
actin and vimentin and
negative immunostaining for desmin and S-100
Surgical resection ®Resolution
of the pain
• The pain appeared after a fall on
his leg.
• Difficulty in walking (+)
• Decreased range of motion in the
knee(+)
(2006) [11]
8 57, F Posterior
aspect of
left knee
ND Orthopedic
surgery
• Plain radiograph
• MRI
• arteriogram
No palpable mass +(6 months) ND • Malignant glomus tumor
• Cords of epithelioid glomus
cells with amphophilic-to-clear cytoplasm and uniform round nuclei in hyalinized stroma separated from the vessels
• Areas of typical benign glomus tumor are surrounded by malignant glomus tumor with mitosis and atypia.
• Positive immunostaining for
SMA.
ND • History of excision of a left
popliteal soft tissue mass
35 year earlier
• MRI demonstrated two nodular
masses in the popiteal fat and two
nodular masses between the
hamstring muscle bellies.
• Difficulty in walking (-)
• Decreased range of motion in the
knee(-)
(2007) [12]
9 33, M Lateral side
of right knee
6 × 12 ×
16 mm
(Direct
measurement
of the
resected
tumor)
Orthopedic
surgery
• Plain radiograph
• MRI
• CT scan
• Arthroscopy
No palpable mass +(10 years) The tumor was present beneath the plica synovialis and had a red aspect, and was a roundish, soft, well limited mass measuring 6 × 12 × 16 mm. Glomangioma Surgical resection
®Resolution
of the pain
• No history of trauma
• Difficulty in walking (+)
• Decreased range of motion in the
knee(-)
(2007) [13]
10 71, M Patella
(No information
on right or left
knee)
60 × 50 ×
50 mm
(Direct
measurement
of the
resected
tumor)
Pathology None A tender subcutaneous
swelling over the patella
+(Several
years)
A subcutaneous, well-
circumscribed mass,
60 × 50 × 50 mm, fixed to the patella
• Glomus tumor with uncertain
malignant potential
• Focal marked nuclear atypia
• The tumor is composed of solid sheets of uniform, small round to short spindle cells interspread with various-sized vessels, some with a hemangiopericytoma-like configuration.
• Tumor cells have round to ovoid nuclei with small or indistinct nucleoli, and slightly eosinophilic cytoplasms with distinct cell border.
• The tumor cells display focal transition from typical glomus cells to elongated cells resembling smooth muscle.
• Some areas show marked pleomorphism, hyperchromatia and hypercellularity.
• There is No atypical mitotic figures.
• Positive immunostaining for SMA, type IV collagen and H-caldesmon
and negative immunostaining for cytokeratin, AE1/AE/3, S-100, CD99, desmin and EMA.
Surgical resection
®ND
No history of trauma (2008) [14]
11 69, M Above the edge
of the proximal
medial
quadrant of the
right patella
10 × 10 mm
(Direct
measurement
of the
resected
tumor)
Orthopedic
surgery
None A soft and bluish mass was visible. +(5 years) • A bluish mass, 10 ×10 mm in size, with visible capillaries passing through in a stellate arrangement,
possibly in the subcutaneous tissue
Glomangioma Surgical resection® Resolution
of the pain
• The pain appeared 3 years after
trauma to the patella.
• Difficulty in walking (-)
• Decreased range of motion in the
knee(-)
(2008) [15]
12 48, F Medial side of
the tibial
tuberosity
of the right
knee joint
23 × 10 × 20
mm
(Ultrasound
scan)
Orthopedic
surgery
• Plain radiograph
• Arthroscopy
• Ultrasound scan
Normal +(3 years) A highly vascular 15 × 20 mm mass which was bluish in color, had the consistency of jelly, and had visible blood vessels traversing, possibly in the subcutaneous tissue • Glomangioma
• Numerous mononucleated
glomus cells with pale and eosinophilic cytoplasm and a
large central round or uniform
oval nucleus and focal
edematous stroma
• Positive immunostaining for
SMA and desmin and negative immunostaining for
chromogranin.
Surgical resection® Resolution
of the pain
• The pain appeared 3 years after
the patient twisted the knee.
• Decreased range of motion in the
knee(+)
(2008) [15]
13 47, M Medial aspect
of the right
knee
8 × 5 mm
(Direct
measurement
of the
resected
tumor)
Orthopedic
surgery
• Plain radiograph
• Ultrasound scan
No palpable abnormality +(1 year) An encapsulated, reddish-brown, fleshy tumor measuring 8 × 5 mm • Glomus tumor
• Rounded glomus cells and
vascular structures
• Association with a well defined nucleus “set off from the amphophilic or eosinophilic cytoplasm”.
Surgical resection® Resolution
of the pain
• No history of trauma
• No description on the histological
location of the tumor
(2009) [16]
14 65, M Lateral
aspect of
the right knee
18 mm
(Ultrasound
scan)
Orthopedic
surgery
• Plain radiograph
• Ultrasound scan
Uniform swelling,
2.5 cm in size
+(10 months) A well-defined 15 × 15 ×
12 mm reddish, fleshy
lesion weighing 3 g in
the subcutaneous tissue
Glomus tumor Surgical resection® Resolution
of the pain
• No history of trauma
• No description on the histological
location of the tumor
(2009) [16]
15 60, M Anterior aspect
of the right
knee
4-5 mm
(Direct
measuring
the
resected
tumor)
Orthopedic
surgery
• Arthroscopy
• Plain radiograph
A small infrapatellar
bursa, 1.5 to 2 cm in diameter
+(4 years) A 4-5 mm fleshy mass • Glomus tumor
• Glomus cells with eosinophilic cytoplasm and large pale round
uniform nuclei
• A surrounding fibrous capsule with numerous vascular
channels
Surgical resection® Resolution
of the pain
• No description on the histological
location of the tumor
(2009) [16]
16 65, M Supero-
lateral aspect
of the patella
(No information
on right or left
knee)
20 × 8 × 4
mm
(Direct
measurement
of the
resected
tumor)
Orthopedic
surgery
•Weight-bearing
radiograph
A small area of
localized swelling
+(ND) A subcutaneous
olive-sized lesion measuring 20 × 8 × 4 mm
• Glomus tumor
• Fibro-fatty tissue with focal
areas of glomus cell and
vascular spaces of varying
sizes
Surgical resection® Resolution
of the pain
• No history of trauma (2009) [16]
17 72, M Anterolateral
aspect of the
left knee joint
10 mm
(Ultrasound
scan)
ND • Plain radiograph
• Ultrasound scan
ND +(1 year) The mass was localized to the
subcutaneous tissue and had a well-defined fusiform shape and a bluish hue with a small
feeding vessel.
• Glomus tumor
• 10 mm × 8 mm × 8 mm tumor
with a thick fibrous capsule,
with numerous dilated
capillaries surrounded by
sheets of small uniform
round cells with round nuclei
Surgical resection® Resolution
of the pain
• The pain appeared 1 year
after total knee replacement
for osteoarthritis.
• The lesion was present near
the scar caused by the operation
for osteoarthritis but did not
involve the scar.
(2009) [17]
18 75, M Inferior border
of the left
anterior knee
15 mm ×
11 mm ×
20 mm
(MRI)
Orthopedic
surgery
• Plain radiograph
• MRI
A soft, mobile, red-purple colorectal lesion, measuring
2 × 2 cm
+(30 years) A well-circumscribed mass in the subcutaneous tissue • Glomangioma
• Glomus cells with uniform,
oval-round shaped nuclei, large eosinophilic cytoplasm, and vascular structures
Surgical resection® Resolution
of the pain
• Decreased range of motion in the
knee(-)
(2010) [18]
19 10, M Medial aspect
of the right
knee
• 50 mm
(Physical
examination
• 65 × 35 ×
15 mm
(MRI)
Pediatric
orthopedics
• Plain radiograph
• MRI
A 5 cm round, well-
circumscribed
mobile mass
+(2 weeks) • After the incisional biopsy, the tumor developed outside the skin and became
mushroom-like
Glomus tumor Surgical resection® Resolution
of the pain
• The pain appeared after a fall on
his leg.
(2012) [19]
20 42, F Inferior aspect
of the patella in
Hoffa’s fat pad
of the right
knee
10 × 10 mm
(MRI)
Orthopedic
surgery
• Plain radiograph
• MRI
• Arthroscopy
• Plain radiograph
• MRI
• Arthroscopy
+(1 year) A pedunculated
8 × 5 mm reddish-brown nodule arising
from Hoffa’s fat pad
• Glomus tumor
• A well-circumscribed,
encapsulated lesion composed
of hyalinized variably sized
blood vessels lined by flattened
endothelium with the
perivascular region showing a
solid proliferation of
monomorphic round to oval
cells with fine chromatin, inconspicuous nucleoli and moderate cytoplasm
• Positive immunostaining for
SMA
Arthroscopic
excision® Resolution
of the pain
- (2013) [20]
21 51, M Lower lateral
portion of the
left knee
ND Orthopedic
surgery
• Plain radiograph
• MRI
• Ultrasound scan
A small, faint
reddish macule
+(8 years) The mass was localized to the
subcutaneous tissue
• Glomangioma
• Round glomus cells with lightly stained cytoplasm and uniform, centrally located oval nuclei
• A prominent vascular
component
• Positive immunostaining for
SMA
Surgical resection® Resolution of
the pain
- (2014) [21]
22 63, M Anterior
aspect of the
knee
superficial
to the patellar
tendon
(No information
on right or left
knee)
22 × 11 mm
(Ultrasound
scan)
Orthopedic
surgery
• Plain radiograph
• Ultrasound scan
A well-defined
subcutaneous,
mobile mass
+(30 years) The mass was subcutaneous, well defined and extended down to the level of the patellar paratenon with no intra-articular extension. • Glomus tumor
• Positive immunostaining for
SMA
Surgical resection® Resolution
of the pain
  (2014) [22]
23 51, M Medial aspect
of the supra-
patellar fat pad
of the right
knee
7 mm
(MRI)
Orthopedic
surgery
• Plain radiograph
• MRI
• Arthroscopy
• Ultrasound scan
ND +(10 years)   • Glomus tumor
• Well-circumscribed
homogenous and vascular
nodule located in suprapatellar
fat pad
• Characteristic round cells, with
eosinophilic cytoplasm, round
and mostly central nuclei, and
the accompanying blood vessels
in a myxoid/hyaline stroma
• Positive staining for caldesmon and SMA
Surgical resection® Resolution
of the pain
• The pain began following a single
episode of low-level trauma.
• Difficulty in walking (+)
• Decreased range of motion in the
knee(+)
(2015) [23]
24 49, M Anteroinferior
aspect of the
left knee
• 60 × 50 ×
50 mm
(Physical
examination)
• 64 × 59 ×
41 mm
(MRI)
Surgery • Plain radiograph
• MRI
The mass demonstrated
small areas of ulceration and surrounding erythema
and warmth.
+(1 year) A gray/brown multinodular, encapusulated, and hemorrhagic mass measuring 55 × 43 × 27 mm in the prepatellar
subcutaneous fat
• Glomangioma
• A monomorphic
population of small,
round, eosinophilic cells with minimal atypia with positive
staining for SMA and negative
staining for cytokeratin, S-100,
and CK-34
Surgical resection® Resolution of
the pain
• The patient was a diesel
mechanic and spent many hours
on his knee and had multiple
episodes of minor penetrating
injuries to the area.
• Decreased range of motion in the
knee(+)
(2015) [24]
25 17, M Left popliteal
fossa
5 mm
(MRI)
Orthopedic
Surgery
• MRI No palpable mass +(3 years) A 5-mm well-circumscribed bluish-red nodule • Glomus tumor
• The tumor comprised vascular,
smooth muscle and neural
components, as well as solid sheets of glomus cells.
• The tumor cells were positive
for a-SMA and negative for desmin.
Surgical resection® Resolution
of the pain
• Difficulty in walking (+)
• Decreased range of motion in the
knee(+)
• No description on the
histological location of the tumor
(2016) [25]
26 38, M Anterior-upper
side of the
patella of
right knee
7 × 3 mm
(MRI)
Orthopedic
Surgery
• Plain radiograph
• MRI
A small whitish
nodule, measuring 10 mm in diameter, not attached to deep planes
+(16 months) A small rounded mass, well delineated, encapusulated and
purplish in the subcutaneous
tissue
Glomus tumor Surgical resection® Resolution
of the pain
No history of trauma (2016) [26]
27 40, F Anteriorlateral
part of the
left knee
• 8 mm
(Physical
examination)
• 4 mm
(MRI)
Orthopedic
surgery
• Plain radiograph
• MRI
A small, firm and mobile nodule
without
inflammatory signs next
+(14 months) A small and well-circumscribed whitish mass Glomus tumor Surgical resection® Resolution of
the pain
• No history of trauma
• No description on the histological
location of the tumor
(2016) [26]
28 22, M Lower end of
the right thigh
18 × 10 mm
(Doppler
ultrasound)
Orthopedic
Surgery
• Plain radiograph
• Doppler
Ultrasound
No palpable mass +(4 years) A tumor measuring
18 × 10 mm, brownish, encapsulated in the
quadriceps tendon
Glomus tumor Surgical resection® Resolution
of the pain
• No history of trauma (2016) [26]
29 82, F Center of the
right patella
10 × 9 × 2
mm
(Physical
examination)
Dermatology None Slightly elevated
subcutaneous nodule with purplish
surface skin
+(6 years) A brown to purplish-gray and encapusulated mass measuring 8 × 6 × 5 mm in the dermis • Glomus tumor
• The tumor cells were positive
for a-SMA, and negative for desmin, CD34, EMA, S-100 and AE1/AE3.
Surgical resection® Resolution
of the pain
• No history of trauma Present case
ND: Not Described; CEA: Carcinoembryonic Antigen; EMA: Epithelial Membrane Antigen; MRI: Magnetic Resonance Imaging; SMA: Smooth Muscle Actin; CT: Computed Tomography

Table 1: Summary of Reported Cases of Glomus Tumour of the Knee.

The mean age of patients was 52.8 years (range: 17-82 years), markedly higher than that for glomus Tumour overall (young adults in the third and fourth decade of life). 3 Our patient was the oldest among the 29 cases reported. Men were affected much more often than women (male-to-female ratio, 23:6), contrasting with the clear female predilection for subungual glomus Tumour, which is a major clinical type of glomus Tumour. 3 Concerning which knee was affected, no difference in laterality was apparent (right-to-left ratio, 15:11; information on laterality was unavailable in Patients 10, 16, and 22). In all except 4 cases, the lesions were located on the anterior side of the knee, such as the patella, medial joint line and lateral side of the knee, while 4 patients (Patients 2, 4, 8, and 25) had lesions on the posterior side of the knee. The depth of lesions was described in 24 cases (information on histological location of the Tumour was absent for Patients 2, 4, 8, 13, 15, 25, and 27). Generally (18 cases), lesions were located in the skin, including the dermis (Patient 29), subcutaneous tissue (Patients 1, 3, 5, 6, 7, 10, 11, 12, 14, 16, 17, 18, 21, 22, 24, 26), and subcutaneous tissue~outside the skin (Patient 19). All cases with lesions in the skin were accompanied by changes in surface skin condition, such as swelling, subcutaneous nodule, and papule. No lesions except that in Patient 19 developed outside the skin surface. In Patient 19, the Tumour developed outside the skin, showing mushroom-like appearance. On the other hand, in some cases, lesions were located deep within the knee joint, such as between the hamstring muscle bellies (Patient 8), beneath the plica synovialis (Patient 9), in the Hoffa’s fat pad (Patient 20), in the suprapatellar fat pad (Patient 23), and in the quadriceps 5 tendon (Patient 28). In those cases, no surface skin change was apparent. Tumour size was variable, ranging from 4-5 mm (Patients 6 and 15) to 60 mm × 50 mm × 50 mm (Patients 10 and 24). Most patients (20 of the 27 cases for which information of the department in which the patient was treated was available) were examined in a department of orthopedic surgery using imaging modalities including plain radiography, magnetic resonance imaging (MRI), and arthroscopy. Only two patients (Patients 4 and 29) were treated in a department of dermatology. All except Patient 4 reported pain over a relatively long period (mean duration, 6.5 years). In most patients, the pain was very severe. For example, Patient 3 described intense pain even on insignificant friction from clothing. In Patient 6, the pain was so severe that he suddenly woke from sleep when bedclothes touched the affected knee. Furthermore, difficulty with walking and/or decreased range of motion in the knee was also observed in some cases. Histopathologically, most lesions were diagnosed as glomus Tumour (21 cases) or glomangioma (7 cases). In the case of Patient 8, the Tumour was diagnosed as malignant glomus Tumour. Immunohistochemcally, lesions were commonly positive for SMA when the immunostaining for this antigen was examined. In addition, lesions in some cases showed positive staining for vimentin (Patients 3, 7, and 29), caldesmon (Patients 10 and 23), and type IV collagen (Patient 10). Concerning desmin, controversial results were obtained. Specifically, the lesion in Patient 12 stained positively for desmin, while lesions in Patients 25 and 29 showed negativities for this antigen. In all cases with benign glomus Tumours and glomaniomas associated with pain, the pain disappeared after resection of the Tumour. In cases where history of injury to the knee was examined, no history of injury to the knee was elicited in 11 cases (Patients 1, 6, 9, 10, 13, 14, 16, and 26-29). Conversely, trauma or mechanical stimulation was suggested to be involved in the development of the lesion in 7 cases (Patients 7, 11, 12, 17, 19, 23, and 24). Our summary of 29 cases of glomus Tumour of the knee revealed that glomus Tumours can develop in the knee in various anatomical sites, including the skin, deep 6 adipose tissue, muscle, quadriceps tendon, and Hoffa’s fat pad. In addition, most patients with glomus Tumour in the knee first visit a department of orthopedic surgery, not a department of dermatology, even when the lesion is accompanied by surface skin changes. This is perhaps because the lesions were situated in deep subcutaneous tissue and were associated with pain, which may make patients think that the lesions are related to the knee joint. However, based on our summary, we would like to emphasize that dermatologists should be aware that glomus Tumour can occur in the skin and consider this Tumour as a differential diagnosis when encountering a patient with a subcutaneous nodule associated with pain.

References

Citation: Nakajima N, Kozaru T, Fukumoto T, Oka M (2018) A Rare Case of Glomus Tumour on the Knee: Case Report and Literature Review. J Dermatitis 3: 110.

Copyright: © 2018 Nakajima N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Post your comment

captcha   Reload  Can't read the image? click here to refresh
Leave Your Message 24x7