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Due to clinical suspicion&#44; he was referred for evaluation with high-frequency ultrasound&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The examination was performed with a 22-MHz linear transducer&#44; disclosing a hypoechoic nodular lesion&#44; with regular&#44; well-defined contours and intensely vascularized on Color Doppler&#44; measuring 2&#46;0&#8239;&#215;&#8239;1&#46;5&#8239;mm in the nail matrix&#44; and discrete bone remodeling &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; Ultrasonographic mapping of the lesion and surgical resection were performed &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Histopathology confirmed the identification of the tumor &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Originating from the glomus bodies&#44; which control blood pressure and temperature by regulating peripheral cutaneous circulation&#44; the glomus tumor is described as a rare benign tumor with a low potential for malignancy&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The clinical manifestation of this type of tumor is represented by the hallmark triad&#58; Love&#39;s pin test &#40;pressure applied to the suspicious area with a pin head causes intense pain&#41;&#44; Hildreth&#39;s Test &#40;pain and reduced sensitivity after applying a tourniquet proximal to the lesion&#41; and the sensitivity test to cold &#40;pain amplification on exposure to cold&#41;&#46; Transillumination testing can help determine tumor size&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Because it is not usually possible to detect nail tumors through inspection and palpation&#44; they are sometimes misdiagnosed&#46; Investigation using complementary imaging tests can help define the diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Currently&#44; there is controversy regarding the diagnostic value of MRI for glomus tumors&#46; Previous studies have demonstrated good diagnostic value&#44; while others suggest poor value&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A useful resource for diagnosing glomus tumors is ultrasound&#44; especially high-frequency ultrasound&#44; which can precisely determine tumor location&#46; The ultrasound is non-invasive and can easily characterize tumors as small as 3&#8239;mm in diameter in any cross-section in the hands of trained operators&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Magnetic resonance imaging depends on intravenous contrast and is not sensitive enough for tumors smaller than 3&#8239;mm&#46; Meanwhile&#44; the ultrasound&#44; in addition to not depending on these factors&#44; offers preoperative information about the tumor to guide the procedure and improve results&#44; demonstrating the potential usefulness of this exam in the evaluation of glomus tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">On ultrasound&#44; glomus tumors are described as well-circumscribed hypoechoic masses&#46; Almost all previously reported cases have shown signs of rich internal blood flow within the hypoechoic area&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Preoperative color Doppler ultrasound can precisely define the following characteristics&#58; tumor location and size&#44; distance to the surface&#44; margins&#44; presence or absence of capsule&#44; and the relationship between the internal circulation and surrounding tissues &#8211; all important parameters for surgical evaluation&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Only surgical resection has been shown to be effective in treating glomus tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">It was believed that MRI was the best test to help find small nail tumors&#44; but with the evolution of ultrasound&#44; especially high-frequency ultrasound&#44; this idea came to be questioned&#46; Ultrasound has proven to be an important diagnostic tool for nail tumors&#44; as good as or even better than MRI&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the present case&#44; the authors were able to locate a small tumor that was not identifiable on MRI and precisely determined the surgical parameters using ultrasound&#46; The aim of the present study was to increase diagnostic possibilities&#44; but more studies are needed to determine the reference imaging tests for nail tumors&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0085" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0090" class="elsevierStylePara elsevierViewall">Athos Paulo Santos Martini&#58; Design and planning of the study&#59; drafting and editing of the manuscript or critical review of important intellectual content&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Ariel C&#243;rdova Rosa&#58; Design and planning of the study&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Marcelo Rigatti&#58; Design and planning of the study&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Gabriella Di Giunta Funchal&#58; Design and planning of the study&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Matheus Hariel Colin Torres&#58; Drafting and editing of the manuscript or critical review of important intellectual content&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Matheus Alves Pacheco&#58; Drafting and editing of the manuscript or critical review of important intellectual content&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Letter - Clinical
Diagnosis of glomus tumor and preoperative mapping with ultrasonography
Athos Paulo Santos Martini
Corresponding author
athosmartini@gmail.com

Corresponding author.
, Ariel Córdova Rosa, Marcelo Rigatti, Gabriella Di Giunta Funchal, Matheus Hariel Colin Torres, Matheus Alves Pacheco
Hospital Universitário da Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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which control blood pressure and temperature by regulating peripheral cutaneous circulation&#44; the glomus tumor is described as a rare benign tumor with a low potential for malignancy&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The clinical manifestation of this type of tumor is represented by the hallmark triad&#58; Love&#39;s pin test &#40;pressure applied to the suspicious area with a pin head causes intense pain&#41;&#44; Hildreth&#39;s Test &#40;pain and reduced sensitivity after applying a tourniquet proximal to the lesion&#41; and the sensitivity test to cold &#40;pain amplification on exposure to cold&#41;&#46; Transillumination testing can help determine tumor size&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Because it is not usually possible to detect nail tumors through inspection and palpation&#44; they are sometimes misdiagnosed&#46; Investigation using complementary imaging tests can help define the diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Currently&#44; there is controversy regarding the diagnostic value of MRI for glomus tumors&#46; Previous studies have demonstrated good diagnostic value&#44; while others suggest poor value&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A useful resource for diagnosing glomus tumors is ultrasound&#44; especially high-frequency ultrasound&#44; which can precisely determine tumor location&#46; The ultrasound is non-invasive and can easily characterize tumors as small as 3&#8239;mm in diameter in any cross-section in the hands of trained operators&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Magnetic resonance imaging depends on intravenous contrast and is not sensitive enough for tumors smaller than 3&#8239;mm&#46; Meanwhile&#44; the ultrasound&#44; in addition to not depending on these factors&#44; offers preoperative information about the tumor to guide the procedure and improve results&#44; demonstrating the potential usefulness of this exam in the evaluation of glomus tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">On ultrasound&#44; glomus tumors are described as well-circumscribed hypoechoic masses&#46; Almost all previously reported cases have shown signs of rich internal blood flow within the hypoechoic area&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Preoperative color Doppler ultrasound can precisely define the following characteristics&#58; tumor location and size&#44; distance to the surface&#44; margins&#44; presence or absence of capsule&#44; and the relationship between the internal circulation and surrounding tissues &#8211; all important parameters for surgical evaluation&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Only surgical resection has been shown to be effective in treating glomus tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">It was believed that MRI was the best test to help find small nail tumors&#44; but with the evolution of ultrasound&#44; especially high-frequency ultrasound&#44; this idea came to be questioned&#46; Ultrasound has proven to be an important diagnostic tool for nail tumors&#44; as good as or even better than MRI&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the present case&#44; the authors were able to locate a small tumor that was not identifiable on MRI and precisely determined the surgical parameters using ultrasound&#46; 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Design and planning of the study&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Matheus Hariel Colin Torres&#58; Drafting and editing of the manuscript or critical review of important intellectual content&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Matheus Alves Pacheco&#58; Drafting and editing of the manuscript or critical review of important intellectual content&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Original language: English
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