Glomus Tumour of Vulva

Shubhangi Vinayak Agale*, Shantilal Sisodia*, Grace Francis D'Costa**,

Vinayak Ganpatrao Agale***

Abstract B. Veer*, Chhaya Chande*, Vaishali Wabale*, Shazia Chavan*,

Pradnya
Kavita
GlomusChopdekar*,
tumour is an Ameeta Joshi**
uncommon, benign vascular neoplasm associated with intense
pain which may be debilitating. Most glomus tumours are diagnosed during adult life
in the subungual region of the finger. Glomus tumours involving female genital tract
are exceedingly rare.
This case report describes a glomus tumour of the vulva in a 25 year old woman,
associated with excruciating pain.

Introduction Vascular spaces within the tumour were lined by

benign endothelial cells. (Fig. 2) There were no

G lomus tumour is an uncommon

benign vascular neoplasm, which
is thought to originate in the
neuromyoarterial glomus. It usually
presents as a solitary frequently painful
skin nodule in the subungual region1
and is occasionally found in anatomic
locations not typically associated with
glomera such as gastrointestinal tract
and the female genital tract.2, 3-9
Case report
A 25 year female presented with excruciating
pain and nodule in the region of vulva since 3
months. On physical examination a 2.0 x 1.5 x 1.0
cm, tender nodule was palpable beneath the left
labia majora. The skin over the nodule was intact.
The gynaecological examination did not reveal
any other lesion.
Pathological findings
Gross : A well circumscribed nodule measured
2.0 x 1.5 x 1.0 cm; cut surface was grayish white
to grayish tan, homogeneous, firm. (Fig.1)
Microscopy : An encapsulated tumour with
predominantly solid appearance and composed of
clusters of cells intimately associated with thin
walled slit-like to vascular channels and small foci
displaying hyaline intercellular matrix. The cells
were regular, polygonal to round with pale to
*Assi. Prof. in Microbiology, **Prof. and Head in
eosinophilic cytoplasm and round to oval nuclei.
Microbiology, Dept. of Microbiology, Grant
Medical College
*Asso. Prof. and Sirand
**Prof. J. J.Head
Groupofof Dept.
Hospital,
of
Pathology, ***Deputy Suprintendent, G.T.
glandular structures or lumina containing
secretions. The stain for reticulin fibres
demonstrated characteristic vascular pattern
with thin wiry reticulin fibres surrounding single
cells. (Fig. 3)
Discussion
Glomus tumours of the female
genital tract are rare. There are
sporadic case reports of glomus tumour
involving the ovary, cervix, vagina and
vulva. 2 - 9 These glomus tumours
occurred in women in the age range of
27-53 years and ranged in size from 0.4
to 5.0 cm, all were well circumscribed,
grayish white. Only the vulval and
clitorial lesions were painful.2 Our
patient was a 25 year female who
presented with a nodule beneath the
labia majora associated with
excruciating pain. On gross
examination the tumour was well
circumscribed, encapsulated, grayish
white, solid. Microscopically
Tsumeyoshi and Enjoyi9 have described
three variants: Vascular, myxoid and
solid. Clinically all the three variants
behaved similarly. A solid glomus
tumour is composed of numerous,
monotonus, rounded glomus cells with

Bombay Hospital Journal, Vol. 53, Special Issue, 2011 557

 Fig. 2 : Tumour is composed of nests of
glomus cells adjacent to vascular channels
with regular nuclei and abundant
cytoplasm (H and E, X100).

Fig. 3 : A prominent network of reticulin

fibres outlining individual cells (Reticulin
stain, X40).
cells are always in close proximity to
numerous small blood vessels. This case
had similar histomorphology to that
Fig. 1 : A well circumscribed nodule
described above.
measured 2.0x1.5x1.0 cm; cut surface was
grayish white to grayish tan, Vulval small neoplasms which
homogeneous, firm.
should be considered in clinical and
eosinophilic cytoplasm and sharply pathological differential diagnosis are
defined cell borders. The nuclei are traumatic neuroma, haemangioma,
regular, central, round or oval, punched
haemangiopericytoma, and adnexal
out with inconspicuous nucleoli. The 7,8
tumours. Occasionally it may be
difficult to differentiate glomus tumour
558 Bombay Hospital Journal, Vol. 53, Special Issue, 2011
from the adnexal sweat gland tumour, 1. Silver SA, Tavassoli FA. Glomus tumour
arising in a mature teratoma of the ovary :
however the presence of vascular report of a case simulating metastasis from
pattern of glomus and the absence of cervical squamous carcinoma. Arch Path Lab
Med 2000;124:1373-1375.
glandular lumina will help to
2. Enziger FM, Weiss SW. Soft tissue tumours.
differentiate glomus tumour from sweat 4th ed. St. Louis: CV Mosby 2001; 985-1001.
gland adenoma.8 3. Sonobe H, Ro JY, Ramos M. et al. Glomus
tumour of the female external genitalia : a
Conclusion report of two cases. Int J Gynaecol Pathol
1994;13:359-364.
The triad of pain, a small nodule and
4. Moldavsky M, Stayerman C, Turani H. Vaginal
the microscopic appearance of glomus glomus tumour presented as a painless cystic
cells with characteristic vascular mass. Gynaecol Oncol 1998; 69:172-174.
pattern is diagnostic of vulval glomus 5. Albores-Saavedra J, Gilcrease M. Glomus
tumour of the uterine cervix. Int J Gynaecol
tumour. Pathol 1999;18:69-72.
References

CIRCUMCISION IN BOYS AND GIRLS : WHY THE DOUBLE STANDARD?

Few countries have banned male circumcision, but even symbolic alternatives to female genital
mutilation are banned in almost all Western jurisdictions.
Legislation to outlaw male circumcision was put forward in Massachusetts and although it was
defeated campaigns continue in other states (see www.mgmbill.org). A better way to protect the
genitals of young boys might simply be to use existing laws. Finally, little boys in the West might be
given the same rights as their sisters, but resistance is peculiarly high and comes from the most
surprising quarters.

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