Mravic Marco, LaChaud Gregory, Nguyen Alan, Scott Michelle A, Dry Sarah M, James Aaron W
University of California, Los Angeles, CA, USA.
University of California, Los Angeles, CA, USA Vanderbilt University School of Medicine, Nashville, TN, USA.
Int J Surg Pathol. 2015 May;23(3):181-8. doi: 10.1177/1066896914567330. Epub 2015 Jan 22.
Glomus tumors are relatively uncommon subcentimeteric benign perivascular neoplasms usually located on the fingers. With their blue-red color and common subungual location, they are commonly confused for vascular or melanocytic lesions. To date there is no comprehensive review of an institutional experience with glomus tumors.
A 14-year retrospective review of all cases within University of California, Los Angeles, with either a clinical or pathological diagnosis of glomus tumor was performed. Data obtained included demographic information, tumor description, pathological diagnoses, immunohistochemical studies, radiographic and treatment information, and clinical course. Rates of concordance between clinical and pathological diagnoses and an evaluation of overlap with other entities were assessed.
Clinical diagnosis of glomus tumor showed concordance with a histopathological diagnosis (45.4% of cases). The most common alternate clinical diagnoses included lipoma, cyst, or angioma. A pathological diagnosis of glomus tumor was most common in the fourth to seventh decades of life. The most common presentation was a subcentimeter lesion on the digit. Deep-seated tumors had a strikingly increased risk for malignancy (33%). Radiological studies were not relied on frequently (18.2% of cases). Immunohistochemical analysis showed diffuse αSMA and MSA expression in nearly all cases (99% and 95%, respectively), with focal to diffuse CD34 immunostaining in 32% of cases.
Our study illustrates trends in the clinical versus pathologic diagnoses of glomus tumor, common competing diagnoses, a difference in demographics than is commonly reported (older age groups most commonly affected), and important differences in the use adjunctive diagnostic tools including radiology and immunohistochemistry.
血管球瘤是相对罕见的小于1厘米的良性血管周围肿瘤，通常位于手指。因其蓝红色外观和常见的甲下位置，常被误诊为血管性或黑素细胞性病变。迄今为止，尚无关于血管球瘤机构经验的全面综述。
对加利福尼亚大学洛杉矶分校所有临床或病理诊断为血管球瘤的病例进行了为期14年的回顾性研究。获得的数据包括人口统计学信息、肿瘤描述、病理诊断、免疫组化研究、影像学和治疗信息以及临床病程。评估临床诊断与病理诊断的一致性以及与其他实体的重叠情况。
血管球瘤的临床诊断与组织病理学诊断相符（45.4%的病例）。最常见的替代临床诊断包括脂肪瘤、囊肿或血管瘤。血管球瘤的病理诊断在40至70岁人群中最为常见。最常见的表现是手指上小于1厘米的病变。深部肿瘤的恶性风险显著增加（33%）。影像学检查使用频率不高（18.2%的病例）。免疫组化分析显示几乎所有病例（分别为99%和95%）均有弥漫性αSMA和MSA表达，32%的病例有局灶性至弥漫性CD34免疫染色。
我们的研究阐述了血管球瘤临床诊断与病理诊断的趋势、常见的鉴别诊断、与通常报道不同的人口统计学差异（最常受累的是老年人群）以及包括放射学和免疫组化在内的辅助诊断工具使用方面的重要差异。
