Recurrent glomus tumor of the pinna: Report of a case.

Abstract

We describe a rare case of a glomus tumor of the pinna. The lesion produced a brief but sharp pain that occurred spontaneously, intermittently, and upon tactile stimulation. Surgical excision with wide margins was successful. We believe this to be only the third case of a glomus tumor of the auricle that has been reported in the literature.

Introduction

Glomus tumors are rare, small, and painful neoplasms of the skin and subcutaneous tissue. They are benign and characteristically solitary lesions that arise from the glomus body, an arteriovenous anastomosis involved in thermoregulation. Glomus tumors are usually seen on the nail beds and fingertips, and they rarely metastasize. These tumors represent less than 1% of all soft tissue tumors; until now, only two cases of a glomus tumor involving the auricle have been reported. In this article, we describe a third case. We treated a patient in whom a pinna glomus tumor recurred after the initial lesion had been excised 9 years earlier. Complete extirpation led to full symptomatic relief.

Case report

A 23-year-old Indian man came to the outpatient otolaryngology clinic reporting the reappearance of a painful lesion on his left earlobe. The pain occurred spontaneously, intermittently, and upon tactile stimulation of the lesion. It was sharp in character and lasted a few seconds at a time. Nine years earlier, the patient had undergone an excision of a mass at the same location; that mass had caused the same type of pain.

On physical examination, we noted a small violaceous lesion on the left ear lobule. It was nodular and approximately 0.4 cm in diameter. Palpation triggered an attack of pain. The remainder of the head and neck examination was unremarkable. No similar lesions were noted elsewhere on the man's body.

This recurrent lesion was addressed surgically. A wide local excision resulted in a complete resolution of symptoms. Pathologic examination identified the lesion as a solid tumor (figure). The patient remains symptom-free 3.5 years later. Followup pathologic evaluation confirms that the excision was complete.

Discussion

The glomus tumor is typically benign and certainly rare, accounting for less than 1% of all soft tissue tumors. It affects the genders equally. It arises from the glomus body, an arteriovenous anastomosis that is normally involved in the regulation of body temperature, blood pressure, and the composition of the interstitial cellular environment. Glomus bodies do not develop until shortly afterbirth, and they tend to atrophy with age. Hence, when these tumors do occur, they are less common at both age extremes.

Anatomically, glomus body tumors are cutaneous-or-deeper soft tissue masses that can occur anywhere on the body surface; they have a predilection for the upper extremities and usually occur subungually. [1]

Clinically, glomus body tumors are typically characterized by paroxysmal attacks of pain. Environmental stimuli such as touch, pressure, and changes in ambient temperature (especially cold) often trigger these attacks. Pain often radiates away from the lesion. [2] Less frequently, these tumors can be asymptomatic and manifest as cutaneous nodules. They typically measure 5 mm to 2 cm in diameter, and they feature a reddish-purple color and a smooth round or oval surface. [3]

Histologically, the glomus tumor is made up of an endothelium-lined vascular bed, which consists of an afferent arteriole, an anastomotic vessel, and a venule surrounded by epithelioid glomus cells. The epithelioid cells have a characteristic appearance, marked by an eosinophilic cytoplasm and a large, round or oval, centrally placed nucleus. Tumors are classified as vascular, myxoid, and solid, depending on the predominant cell type (endothelial vs. epithelioid). When endothelial cells predominate, the tumor is classified as vascular; when epithelioid cells are in the majority, the tumor is solid. [4] Glomus tumors can be encapsulated or unencapsulated. The former are more common.

Glomus tumors are classically solitary and sporadic. Familial clustering has been described. The inheritance pattern is autosomal-dominant, with incomplete expressivity and variable penetrance. Malignant lesions have also been reported, and they tend to be locally infiltrative. Metastases are rare. [5]

References

(1.) Heys SD, Brittenden J, Atkinson P, Eremin O. Glomus tumour: An analysis of 43 patients and review of the literature. Br J Surg 1992;79:345-7.

(2.) Yoshida GY. Glomangioma of the auricle. Otolaryngol Head Neck Surg 1995;113:833-4.

(3.) Strahan J, Bailie HW. Glomus tumour. A review of 15 clinical cases. Br J Surg 1972;59:91-3.

(4.) Tsuneyoshi M, Enjoji M. Glomus tumor: A clinicopathologic and electron microscopic study. Cancer 1982;50:1601-7.

(5.) Brathwaite CD, Poppiti RJ Jr. Malignant glomus tumor. A case report of widespread metastases in a patient with multiple glomus body hamartomas. Am J Surg Pathol 1996;20:233-8.