Glomus tumors, extremely rare in childhood, are rare
hamartomatous lesions that are derived from the glomus
body, a temperature-regulating receptor located in the
deep dermis. A glomus tumor is characterized by excessive
proliferation of vascular structure with distinctive
large cells, the glomus cells, associated with thickened
endothelium[
1-
3]. They are purple to red in color and
typically range in size from 1 to 5 mm in diameter. The
triad of pain, tenderness, and sensitivity to cold is typical
of a glomus tumor[
1,
2]. The tumor may occur anywhere in
the body, although the most common site is the subungual
region of the fingers. Glomus tumors arising primarily
within bone is quite rare[
4,
5]. Differential diagnosis of
intraosseous glomangioma includes epidermal inclusion
cyst, enchondroma, chronic osteomyelitis, sarcoidosis,
metastases, subungual melanoma and OS[
4,
5].
Osteochondromas are benign proliferations composed
of mature bone and a cartilaginous cap. They usually arise
from the metaphysis near the growth plate of long tubular
bones. Most OCs are asymptomatic, but some may cause
disturbing cosmetic deformities. They occur most often as
solitary, sporadic lesions, however they may be multiple
in rare familial disorders[7,8].
Solitary OCs have a characteristic radiographic
appearance. Radiographically, they appear bony outgrowth,
sessile or pedunculated[7,8]. However, for intraosseous
glomangioma, the radiographic appearance resembled that
of an OC, epithelial inclusion cyst or bone cyst. Pathologic
examination is necessary for correct diagnosis in the
intraosseous glomangioma diagnosis[4,5].
In our case, the patient had two masses on his right
leg. The first one was present as a localised swelling
on his right proximal leg since he was 6 years old. It
was originally 1x1 cm, then progressively hardened
and enlarged to 4x3 cm. The second mass was on his
right distal leg. He had no complaint for either of these
swellings. The first mass’ radiological examinations
revealed OC. The other’s MRI showed calcification and
high vascularity within the substance of the tumor without
continuity with the underlying bone. The masses were
completely excised. On histopathological examination,
the first tumor was diagnosed as OC. The second tumor
consisted of vascular channels that anastomosed in a
cavernous-like pattern. These vascular spaces were lined
with flattened endothelial cells. The vascular walls were
thick and contained small round cell outlines. No mitosis
or necrosis was observed.
Treatment of these benign tumors is surgery. For
glomangioma, the surgery can be difficult as identification
of the glomus tumor is challenging because it is often
small and indistinguishable from the surrounding
tissues. This may be the cause of unsuccessful surgery
in some cases[2,3]. A 15% rate of recurrence following
surgery has been reported[3]. However, when a doubletourniquet
technique during dissection and tumor excision
was performed, no recurrence was observed[2]. In OC,
should it be symptomatic, simple resection at the base
of the lesion is the traditional treatment method[7,8]. In
our case, two masses were completely excised. There has
been no recurrence of lesions for five years.
In summary, glomangioma is a rare benign vascular
tumor. The most common site is the subungual region of
the finger. Glomangiomas arising primarily within bone
are extremely rare and it can be misdiagnosed as OC. We present a case with glomus tumor and OC on the same
leg. To the best of our knowledge, this association of
glomangioma and OC has not been previously reported
in the literature.
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