GLOMUS TUMOR OF THE HAND

J. Boukhris, O. Margad, O. Azriouil, M. Daoudi and K. Koulali idrissi. Department of Orthopaedic and Traumatologic Surgery – Avicenne military hospital – Marrakech – Morocco. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 5(12), 1473-1478 1474 Complementary examinations were based on the X-Ray, which showed a bone in 1 patient, on the ultrasound, made in 1 patient who showed hypoechoic mass, and on the MRI performed in 5 patients. made it possible to locate the tumor and to specify its volume.
The treatment was surgical in all cases with complete resection of the tumor (Fig.5). The pathological study, performed in all cases, confirmed the diagnosis. There were 2 cases of recidivism, which were favorably resumed. The results were satisfactory in all the cases with spectacular disappearance of the pain, no case of nail dystrophy was noted, the cicatrisation with functional recovery was obtained in 3 weeks in case of peri-ugueal approach and 5 weeks for first trans-ungual.

Discussion:-
The glomus tumor is a benign tumor, rare but not exceptional (1), it represents 1.6 -5% of tumors of the soft parts of the hand (2). Females are more likly to have them especially in the digital location in subungual (3), in our series there appears a clear female predominance, these data join the results of the other series. The latter show that the age or diagnosis is posed very regularly around 20 to 65 years, our results are similar to those of the literature since the average age is 42 years. The glomos tumor is developed at the expense of the neuromyarterial glomus Masson which 1477 is located mainly at the extremities especially at the level of the fingers, which explains the frequency of glomus tumors of the hand.
Localization predominates in the nail bed very rich in glomus. Pain is the earliest symptom, the most characteristic in the glomus tumor evolving paroxysmally. Its dazzling and atrocious character contrasts with the discretion or absence of local signs (3). The differential diagnosis is vast but the clinic simplifies the problem.
When the triad: algie, trigger zone, hypersensitivity to cold is found, there is no longer any diagnostic doubt.
Complementary examinations are based on: X-Ray, which is the only examination systematically performed by all authors in the context of a painful lesion of the extremities.
It is important in case of clinical suspicion to search for these signs with relentlessness, Fornage (4) suggests besides to do this radiography with a low-voltage device like mammography. In our series, standard radiography was performed in all patients; it showed erosion of the 3rd phalanx in one case (observation 1).
Ultrasound makes it possible to visualize glomic tumors of very small size without physical signs or apparent radiological manifestations. This method has been used by Fornage since 1988 (4). While ultrasound has the advantage of being safe, non-invasive and less expensive, its specificity varies from 51% to 77% (4). This examination was performed in 2 patients of our series, it was a well-defined round image, hypoechoic, in the first case, and it returned negative in the second case.
MRI is the most effective way to make the diagnosis and especially to locate the tumor especially if it is guided by the ultrasound. Classical MRI is nonspecific, and gives false negatives for tumors smaller than 3 mm. We have improved the MRI, performed in high resolution, this allowed to improve the false negatives, the lesions show a hyposignal in T1 and a hypersignal in T2 (5) (6). Apart from the diagnostic aspect, MRI is a method of choice for surgical tactics: the precise information provided on the size and location of the tumor has made it possible to limit and guide the approach. In our series, MRI was performed in 8 patients (Fig.6), which made it possible to locate the tumor well and to specify its volume.

with clear contrast between what is normal tissue and what is tumor
The positive diagnosis of certainty can only be made by histology. The treatment is exclusively surgical, it allows to confirm a diagnosis often uncertain by a histological examination of the tumor and to remove the pain.
For subcutaneous or pulpal tumors, the approach is direct, respecting the principle of cutaneous incisions, avoiding the path of nerve twigs (7). When the tumor is under a nail, the problem is to prevent the occurrence of post-surgical nail dystrophy (8), the peri-ugual approach allows a double access pulp and under a nail and respects relatively the ungual apparatus, it is however deep and rather difficult in the central locations, thus making the bed with recurrences (7). The trans-ungual approach was widely used (3), but because of the major nail dystrophies it caused, it declined in the periungual approach. It is no longer appropriate to perform total resection without optical magnification, since the size of the tumor is often small and rarely exceeds 10 mm more than the approach of the nail bed and the matrix often requires a microsurgery (7). After complete tumor removal, the results are generally considered excellent. In the majority of cases, the disappearance of the pain is fast and the finger or the member concerned resumes its normal appearance in 3 months (6).
Complications are dominated by recurrences, which are not uncommon; according to recent studies, 4 to 24% of patients require a new intervention (3), so most authors believe that recurrence is due to insufficient excision. Ungual dystrophies are related to the lesion of the germinal matrix or the non-restoration of the nail bed, they can also be related to the adhesion of the eponychium with the matrix by the non-restitution of the nail and the irregularity of the nail. surface of the nail bed after surgery (8).

Conclusion:-
The glomos tumor appears as a confusing pathology, first of all because of its rarity, then of its particular clinical expression. Although the clinic is rather univocal by the classic association of intense pain with hypersensitivity to cold, the examination is not very helpful because the objective signs are inconsistent. The diagnosis has largely benefited from the contribution of modern imaging, including MRI which allows to give more details on the volume and the tumor site. The diagnosis of certainty can only be made by histology. The treatment is exclusively surgical,