Kloping Laskar Pradnyan, Widhiyanto Lukas, Irianto Komang Agung, Sindrawati Oen, Kloping Yudhistira Pradnyan
Department of Orthopaedic and Traumatology, Faculty of Medicine, Airlangga University, Dr. Soetomo General Hospital, Surabaya, Indonesia.
Department of Orthopaedic and Traumatology, Faculty of Medicine, Airlangga University, Dr. Soetomo General Hospital, Surabaya, Indonesia.
Int J Surg Case Rep. 2020;75:352-356. doi: 10.1016/j.ijscr.2020.09.093. Epub 2020 Sep 17.
Glomus tumor located in the lower limb could be easily mistaken as lower extremity pain whether it is radiating, sciatic, or just a localized one. This could lead to misdiagnosis and improper management.
This case reported a 56-year-old man complaining of pain in his left thigh. The pain was characterized as sharp and sometimes radiated to the skin of the calf muscles region. There was no history of trauma. Physical examination of the left thigh region revealed a small and barely palpable deep subcutaneous mass. Ultrasound examination showed a 6 × 5.3 mm partly cystic subcutaneous mass in the posteromedial region of the left distal femur. Doppler USG showed that the blood flow in the cystic lesion originated from the medial genicular artery. Surgical tumor excision through the medial femoral approach exposed a 15 × 10 × 5 mm yellowish-white thin encapsulated subdermal tumor attached to the vascular wall. Histopathology examination resulted in a Glomus Tumor.
Glomus tumor usually occurs in areas that are rich in glomus bodies. Thigh is not a specific location for glomus bodies. It presented as bluish small nodule that are sensitive to touch and temperature changes. Glomus tumors in the thigh region rarely recurs since they are solitary and encapsulated, making them easily recognizable from the surrounding tissue during the operation.
Meticulous history taking, physical examination, and imaging modalities are necessary to differentiate between tumor and non-tumor lesions in less common areas.
位于下肢的血管球瘤无论表现为放射性疼痛、坐骨神经痛还是局限性疼痛,都很容易被误诊为下肢疼痛。这可能导致误诊和不当治疗。
本病例报告了一名56岁男性,主诉左大腿疼痛。疼痛性质为锐痛,有时放射至小腿肌肉区域的皮肤。无外伤史。对左大腿区域进行体格检查发现一个小的、几乎触不到的深部皮下肿块。超声检查显示左股骨远端后内侧区域有一个6×5.3毫米的部分囊性皮下肿块。多普勒超声显示囊性病变内的血流起源于膝内侧动脉。通过股内侧入路进行手术肿瘤切除,暴露了一个15×10×5毫米的黄白色薄包膜皮下肿瘤,附着于血管壁。组织病理学检查结果为血管球瘤。
血管球瘤通常发生在富含血管球的区域。大腿并非血管球的特定发生部位。它表现为蓝色小结节,对触摸和温度变化敏感。大腿区域的血管球瘤很少复发,因为它们是孤立的且有包膜,在手术过程中很容易与周围组织区分开来。
在不太常见的区域,细致的病史采集、体格检查和影像学检查对于区分肿瘤性和非肿瘤性病变是必要的。