Vasilevska-Nikodinovska Violeta, Samardjiski Milan, Jovanovik Rubens, Ilievski Boro, Janevska Vesna
University Surgical Clinic "St. Naum Ohridski", Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia.
University Orthopedic Clinic, Clinical Center "Mother Theresa", Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia.
Open Access Maced J Med Sci. 2019 Dec 10;7(23):4082-4088. doi: 10.3889/oamjms.2019.610. eCollection 2019 Dec 15.
Glomus tumors are rare neoplasms accounting for less than 2% of all soft tissue tumors but multiple lesions may be seen in up to 10% of the patients. Solitary glomus tumor (GT) most frequently appears as small nodule in specific locations such as subungual region or deep dermis. However, rarely these entities have been observed in extracutaneous locations such as the gastrointestinal, cardiovascular, respiratory tracts, and other visceral organs. A small fraction of the GTs may present as tumors of uncertain malignant potential or as malignant glomus tumors.
We report a patient with multiple glomus tumors on the time of diagnosis, which was histologically diagnosed as an atypical glomus tumor following resection of a tumor thrombus in the left renal vein, inferior vena cava trombus with intracardial extension, and mitral valve specimen. The intramuscular lesion from the thigh was diagnosed as a glomus tumor of uncertain malignant potential. Further examinations revealed multiple lesions trough her body: kidneys, breast, heart and subcutaneous tissue. The diagnosis of glomus tumor of uncertain malignant potential versus glomus tumor with low malignant potential could be quite challenging, and the clinical course may be as a determining factor for final diagnosis.
To our knowledge, this is the only known case of glomus tumor with multiple organ involvement and aggressive biological behavior at presentation.
血管球瘤是罕见肿瘤,占所有软组织肿瘤的比例不到2%,但高达10%的患者可能出现多发病变。孤立性血管球瘤(GT)最常表现为特定部位的小结节,如甲下区域或真皮深层。然而,在胃肠道、心血管、呼吸道及其他内脏器官等皮肤外部位很少观察到这些肿瘤。一小部分血管球瘤可能表现为恶性潜能不确定的肿瘤或恶性血管球瘤。
我们报告一例患者,诊断时患有多发血管球瘤,在切除左肾静脉肿瘤血栓、下腔静脉血栓伴心内扩展及二尖瓣标本后,经组织学诊断为非典型血管球瘤。大腿部的肌肉内病变诊断为恶性潜能不确定的血管球瘤。进一步检查发现其全身多处有病变:肾脏、乳腺、心脏和皮下组织。区分恶性潜能不确定的血管球瘤与低恶性潜能的血管球瘤颇具挑战性,临床病程可能是最终诊断的决定因素。
据我们所知,这是目前已知的唯一一例血管球瘤在初诊时累及多个器官且具有侵袭性生物学行为的病例。