Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2815
Peer-review started: March 23, 2019
First decision: May 31, 2019
Revised: June 25, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: September 26, 2019
Glomus tumor is an uncommon benign tumor usually presenting with a small mass occurring in the dermis or soft tissue of an extremity, especially subungual region. However, intraneural glomus tumor is sporadic. While most of the glomus tumors are benign, atypical glomus tumors with unusual features can be occasionally found, leading to distinctive malignant potential required different therapeutic approaches. Glomus tumor of uncertain malignant potential is one type of atypical glomus tumor with limited criteria for malignancy and without metastasis.
Herein, we report a case of a 48-year-old Thai male with a large painful mass in his axilla for one year without apparent neurological deficit. Magnetic resonance imaging showed a large heterogeneous mass encasing entire posterior cord of left brachial plexus and axillary artery. The tumor tissue from core needle biopsy histologically demonstrated the sheets and cords of relatively uniform tumor cells with foamy cytoplasm and round to oval hyperchromatic nuclei without atypia. The mitotic count was 0 per 50 high power field. A final diagnosis of glomus tumor of uncertain malignant potential was rendered. Complete surgical resection was performed, followed by adjuvant radiation due to positive margin. Neither local recurrence nor distant metastasis was observed at 2-year follow up. Unfortunately, postoperative incomplete brachial plexopathy without signs of re-innervation by electromyography was persisted. Later nerve grafting reconstruction was performed, followed by ongoing neurological rehabilitation.
Glomus tumor of uncertain malignant potential is exceedingly rare, especially around brachial plexus. Although the prognosis is good, careful histological diagnosis and treatment are needed to achieve an optimal outcome with lower morbidity.
Core tip: Atypical glomus tumors are a group of sporadic glomus tumors exhibit unusual characteristics of malignancy. The glomus tumor of uncertain malignant potential is defined as atypical glomus tumor with at least one, but not all, malignant feature. Moreover, atypical glomus tumor around the nerve region is exceedingly rare and mimic various types of sarcoma, leading to inaccurate diagnosis and inappropriate treatment. Careful histologic diagnosis and a multidisciplinary approach are essential for better clinical outcome with less morbidity. In this report, we present a patient with an extensive glomus tumor of uncertain malignant potential in brachial plexus.