Komforti Miglena, Cummings Thomas J
Department of Pathology, Duke University Medical Center, Durham, NC.
Am J Dermatopathol. 2015 Sep;37(9):719-20. doi: 10.1097/DAD.0000000000000374.
Glomus tumor is a benign neoplasm of the glomus body, a neuromyoarterial structure that regulates temperature and pressure in the cutaneous vasculature. Approximately 1%-4.5% of glomus tumors present in the hands of females; of these, 65% are seen in the subungual region of the index and long fingers. Pacinian hyperplasia is a benign lesion of the Pacinian corpuscle, a mechanoreceptor located in the subcutis of the hands and feet.
A 65-year-old woman with a history of hand trauma and a 1-year chief complaint of tingling, pain, and burning sensations in her proximal thumb underwent exploration of the digital nerve after an x-ray and 2 magnetic resonance imaging examinations failed to detect a mass. Two lesions immediately adjacent to each other were excised.
Microscopic examination showed Pacinian hyperplasia, and a second proliferation of solid epithelioid cells related to benign blood vessels. Immunohistochemistry confirmed the epithelioid cells to be strongly positive for smooth muscle actin, CD34, and type 4 collagen, which is consistent with the phenotype of a glomus tumor. The cells were negative for S100 protein.
The association of glomus tumor with Pacinian hyperplasia has rarely been reported in the literature. We present another rare case to bring awareness to this differential diagnostic consideration.
血管球瘤是一种血管球的良性肿瘤，血管球是一种神经肌动脉结构，可调节皮肤血管系统中的温度和压力。约1%-4.5%的血管球瘤出现在女性手部；其中，65%见于示指和中指的甲下区域。帕西尼小体增生是帕西尼小体的一种良性病变，帕西尼小体是一种位于手足皮下的机械感受器。
一名65岁女性，有手部外伤史，主要诉近端拇指刺痛、疼痛和烧灼感1年，在X线和2次磁共振成像检查均未发现肿块后，对其指神经进行了探查。切除了两个紧邻的病变。
显微镜检查显示为帕西尼小体增生，以及与良性血管相关的实性上皮样细胞的第二种增生。免疫组织化学证实上皮样细胞平滑肌肌动蛋白、CD34和IV型胶原呈强阳性，这与血管球瘤的表型一致。细胞S100蛋白阴性。
血管球瘤与帕西尼小体增生的关联在文献中鲜有报道。我们报告另一例罕见病例，以引起对这种鉴别诊断的关注。
