Glomus Tumors of the Hand

Glomus tumors of the hand are hamartomas developed from the neuromyoarterial apparatus, which normally function as a controlled arteriovenous anastomosis to regulate peripheral blood flow in the digits.

Glomus tumors are most commonly found in the subungual region. The lesion shown here is located in the lateral portion of the proximal nail fold and demonstrates T2 hyperintensity (top) and mild, heterogeneous enhancement (bottom). The lesion was not seen on T1-weighted images (not shown).

Most glomus tumors are T1 iso- or slightly hyperintense to the dermal layers of the nail bed and strongly hyperintense on T2-weighted images. Glomus tumors usually demonstrate heterogeneous enhancement, likely reflecting the mixed histology of these tumors, which contain vessels, glomus cells, and mucoid tissue. It must be noted that the normal dermis beneath the nail matrix demonstrates strong, homogeneous enhancement.

Differential considerations include

• Mucoid cysts: Classically located in the proximal nail fold; painless. There is no contrast enhancement and there is a pedicle communicating with the distal interphalangeal joint.
• Angiomas: Have the same signal features as gloomus tumors, but are more superficial and located in the papillary dermis and the epidermis.

References

Drapé JL, Idy-Peretti I, Goettmann S, Wolfram-Gabel R, Dion E, Grossin M, Benacerraf R, Guérin-Surville H, Bittoun J. Subungual glomus tumors: evaluation with MR imaging. Radiology. 1995 May;195(2):507-15.