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Subungual glomus tumor

Glomus tumor (rather hamartoma) constitutes 1–5% of the soft-tissue tumors in the hand usually occur under the fingernail, between the ages of 30 and 50, twice as often to women as men. The normal glomus (glomus body) is an arteriovenous shunt that is composed of an afferent arteriole, an anastomotic vessel (Sucquet-Hoyer canal), a collecting vein, and a capsular portion.

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Glomus tumor constitutes 1–5% of the soft-tissue tumors in the hand. Fifty percent of these occur under the fingernail, usually to people between the ages of 30 and 50 years, twice as often to women as men. The normal glomus (glomus body) is an arteriovenous shunt that is composed of an afferent arteriole, an anastomotic vessel (Sucquet-Hoyer canal), a collecting vein, and a capsular portion. Histologically analysis shows vascular channels surrounded by irregularly arranged cuboidal cells. Nerves are found and may account for the pain. The tumor is surrounded by a fibrose capsule. Glomus tumor may be considered a hamartoma rather than a true tumor.
Clinically they produce a number of symptoms: marked pain, cold intolerance, very tender, with a blue discoloration of the fingernail.
Because the glomus is richly vascularized, it shows marked contrast enhancement on MRI after IV injection of gadolinium.
Other possible diagnoses include mucoid cyst, hemangioma, epithelial inclusion, and tendon giant cell tumor. Treatment is by surgical excision, and MRI may be helpful before surgery to locate the tumor and ensure complete excision with removal of the capsule to prevent possible recurrence.

References:
Christian E. A. Van Ruyssevelt and Patrick Vranckx. Subungual Glomus Tumor: Emphasis on MR Angiography. AJR 2004; 182:263-264
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