A 72-year-old woman was referred from another hospital because of painful subcutaneous lesions on her second finger of the right hand.
One year before, he had debuted with painful subcutaneous nodules that were treated surgically, although he did not add anatomopathological report, with recurrence of lesions at 3 months for which treatment with topical corticotherapy and oral analgesia was applied.
A subsequent biopsy confirmed the diagnosis of TGM, after which an extension study was performed and the patient was referred to our center for definitive treatment.
Magnetic resonance imaging (MRI) of the hand identified an extensive soft lesion of the second finger, elongated and elongated, with an interphalangeal diameter of 5.2 cm from the proximal metaphalangeal joint to the second.
It proximally had a deep and lateral location to the flexor tendons of the finger, with which it contacted, as well as the first dorsal interosseous muscle and bone at the level of the second, the metaphalangeal joint.
Distal to it was located superficially and affected the subcutaneous cellular tissue of the volar and lateral region of the finger, with a new point of contact with the flexor tendons immediately distal to the proximal interphalangeal joint.
The lesion was hypointense on T1-weighted sequences, with intermediate heterogeneous signal intensity on T2-weighted sequences and intense diffuse gadolinium enhancement.
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Positron emission tomography (PET-CT) with 18 fluorodeoxyglucose did not show macroscopic malignant, metabolically active disease.
Our initial evaluation showed the presence of erythematous-rosaceous nodules, larger than 1 cm, painful to the second fixation of the non-mobile hand, hard consistency, located on the radial edge and proximal metaphonic surface.
No supraclear or axillary lymph nodes were found.
The range of articular mobility of the affected finger was not limited.
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One month after the initial evaluation, we performed amputation of the second radius of the right hand with section of the tendon of the superficial flexor and deep tendon of the second finger in zone V flexor, of the tendon of the extensor digitorum second.
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In the macroscopic study of the amputated piece, there were several subcutaneous greyish nodules covering a 4 x 2.5 cm surface in the proximal and metaphalangeal joints.
In the histological study, the tumor had a periplexiform architecture and was located in the depth of the palange.
Tumor cells were closely related to small-caliber vessels, sometimes with positive PAS staining around cells, as in the case of TG.
The cells had a fusiform and focal epithelioid morphology, with moderate atypia and a mitotic rate of 4 mitosis in 10 high-power fields.
No mitoses or tumoral necrosis were identified.
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Immunohistochemical techniques showed diffuse positivity for smooth muscle actin and vimentin, with cell-to-cell marking of type IV collagen and negativity for CD34, caldesmon, desmin, keratins and S100.
Both the presence of areas that measured TG morphology and immunohistochemical tests supported the glomus nature of the tumor.
To make the diagnosis of malignancy we used the criteria proposed by Folpe et al. given the size greater than 2 cm and the deep location(9) Other criteria of malignancy that we did not find in this case are the presence of marked mycosis a
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The surgical margins of the resection specimen were tumor free, without lymphovascular invasion, but with a nodule at 1 mm from the surgical margin.
TNM staging of the tumor after the complete study was pT1bN0M0.
Subsequently, the patient was given adjuvant radiotherapy on a planned target volume that included the surgical bed as well as the volar and dorsal scars.
The total dose was 66 Gy, with staging of 2 Gy/fraction, 5 episodes/ week.
Eighteen months after surgery, the patient continues with periodic reviews, with no signs of tumor recurrence.
For the review of the literature on the subject that completes this work, we used PubMed introducing as search terms "malignant glomus tumor".
