Intraosseous Glomus Tumor of the Ankle: A Case Report and Review of the Literature

Glomus tumors are benign vascular lesions composed of uniform round to oval cells, resembling normal glomus bodies that can be classified as paragangliar tissue derived from neural crest, which participates in thermal regulation. They usually occur in the peripheral soft tissues, most frequently in the digits, where the glomus bodies are normally present. However, they may arise in diverse locations such as bone, stomach, intestines, or neural tissue, where the glomus bodies are thought to be sparse or even absent. Glomus tumors can be solitary or multiple. The solitary acquired form is more common. Multiple glomus tumors are rare and are inherited as an autosomal dominant trait. The onset usually is in adolescence with a male predominance; between 30 and 60 years, the predominance is female. The tumor consists of glomus cells, vascular structures, and smooth muscle tissue in varying proportions. Glomus tumors have been divided into three groups according to the relative proportions of these components: glomus tumor proper, glomangioma, and glomangiomyoma. In case of histologic uncertainty, immunohistochemical features may be helpful for differential diagnosis, including hemangiopericytoma, leiomyosarcoma with epithelioid change, rhabdomyosarcoma, Ewing sarcoma, and nodular hidradenoma. Glomangiomas, which usually are encountered in patients with multiple lesions, constitute approximately one fifth of the cases and are predominately on the hand and forearm. Pain radiating proximally or distally from the lesion is the most common complaint. The classic diagnostic triad consists of local pain, tenderness to pressure, and cold hypersensitivity. The pain is elicited by changes in temperature, emotional excitement, and even minimal touch on the lesion. The pain is partially mitigated by nonsteroidal anti-inflammatory medications.