Glomus tumors are rare benign neoplasms that predominate in limbs. Infrequently, they can occur in a wide anatomic distribution, to include sites not known to contain glomus cells. Although glomus tumors are usually small, pain and tenderness are common clinical symptoms. We report the case of a 69-year-old man with an asymptomatic large mediastinal glomus tumor, who underwent surgical resection.
Glomus tumors are thought to arise from the glomus body, a specialized thermoregulatory shunt highly concentrated in the fingers and toes. Most lesions are solitary and localized to cutaneous sites; however, they may have extracutaneous involvement [
A 69-year-old man suffered from benign prostatic hyperplasia and was hospitalized in the urology department of our hospital in order to undergo a transurethral resection of the prostate. The routine preoperative chest X-ray (Figure
Chest X-ray film showing the tumor located to the posterior mediastinum.
(a) Computed tomography showing the tumor to the right posterior mediastinum at the level of T3 vertebral body. (b) Solid sheets of glomus cells (double arrow) around dilated vessels (simple arrow). Hematoxylin and eosin stain, original magnification ×100.
Our patient underwent a right posterolateral thoracotomy through the 5th intercostal space. A well-circumscribed vascular lesion was resected en bloc with macroscopically clear margins. The right thoracic cavity was drained by a single chest tube 32F. The patient made an uneventful postoperative recovery and he was discharged on the fifth postoperative day. Pathology report showed a benign glomus tumor of the mediastinum measuring 4.5 × 4 × 2.5 cm, with clear resection margins (Figure
Glomus body is specialized arteriovenous anastomosis found most often in the fingers and is characterized by an afferent arteriole, Sucquet-Hoyer canal, and an efferent venule. Glomus cells surround this arteriovenous anastomosis, due to their ability of contraction, which play an important role in thermoregulation [
Mediastinal location is very rare. To the best of our knowledge, six cases have been described in the English literature so far [
Glomus tumors are typically composed of 3 components: glomus cells, vasculature, and smooth muscle cells. They may be subcategorized as solid glomus tumor (with poor vasculature and scant smooth muscle component), glomangioma (with prominent vascular component), or glomangiomyoma (with prominent vascular and smooth muscle components). Solid glomus tumor is the most common variant (75%) followed by glomangioma (20%) and glomangiomyoma (5%) [
Glomus tumors consist of branching vascular channels lined by endothelial cells, interspersed by round glomus cells forming nests, sheets, and trabeculae [
Most glomus tumors are solitary and sporadic, but some cases of glomus tumor are multiple. These disseminated variants of glomus tumor, known as glomangiomas, differ clinically from solitary glomus tumors and have been linked to chromosome 1p21-22 and are caused by truncating mutations in glomulin [
In rare cases, malignant transformation within glomus tumors, which produce surrounding tissues infiltration, has been described [
The most reported symptoms of glomus tumors were pain, local tenderness, and cold hypersensitivity mainly in cutaneous lesions. Rarely, patients are asymptomatic and glomus tumor is an incidental finding [
The treatment of choice for solitary glomus tumors is total surgical excision with clear macroscopic margins, which is curative. Benign lesions do not need adjuvant therapy.
The prognosis for patients with glomus tumors is excellent. Excision of painful lesions most often results in cure, with a low recurrence rate for solitary lesions.
The authors declare that there is no conflict of interests regarding the publication of this paper.