Glomus Tumor of the Oral Cavity: Report of a Rare Case and Literature Review

Sánchez-Romero, Celeste; Oliveira, Maria Eduarda Pérez de; Castro, Jurema Freire Lisboa de; Carvalho, Elaine Judite de Amorim; Almeida, Oslei Paes de; Perez, Danyel Elias da Cruz

doi:10.1590/0103-6440201902222

Celeste Sánchez-Romero

Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil

http://orcid.org/0000-0001-5365-2692

Maria Eduarda Pérez de Oliveira

School of Dentistry, Oral Pathology Section, Department of Clinical and Preventive Dentistry, UFPE - Universidade Federal de Pernambuco, Recife, PE, Brazil

http://orcid.org/0000-0003-3265-2671

Jurema Freire Lisboa de Castro

School of Dentistry, Oral Pathology Section, Department of Clinical and Preventive Dentistry, UFPE - Universidade Federal de Pernambuco, Recife, PE, Brazil

Elaine Judite de Amorim Carvalho

School of Dentistry, Oral Pathology Section, Department of Clinical and Preventive Dentistry, UFPE - Universidade Federal de Pernambuco, Recife, PE, Brazil

Oslei Paes de Almeida

Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil

Danyel Elias da Cruz Perez

School of Dentistry, Oral Pathology Section, Department of Clinical and Preventive Dentistry, UFPE - Universidade Federal de Pernambuco, Recife, PE, Brazil

http://orcid.org/0000-0002-4591-4645

Correspondence: Danyel Elias da Cruz Perez, 4ª Travessa Professor Artur de Sá, s/n, Cidade Universitária, 50740-521 Recife, PE, Brazil. Tel. +55-81-2126-8342. e-mail: danyel.perez@ufpe.br

Figures (3)
Tables (2)

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Figure 1
Histopathological features of glomus tumor. (A) At low power magnification, it is observed an encapsulated proliferation of round cells surrounding numerous convolutions of varying sized vessels in a myxoid stroma. The fibrous capsule contained numerous blood vessels and small nerve bundles (HE 25´). (B) Within the tumor, some larger vessels presented a prominent thickness of its wall in the form of a spindle cell nodule that protruded into the lumen (HE 200×). (C) Most of the tumor cells were rounded or ovoid, with epithelioid aspect and tenuous cellular membrane. The cytoplasm was eosinophilic and, in focal cells, it was clear. The nuclei was prominent with well-defined nuclear membrane and some showing inconspicuous nucleoli (HE 400×). (D) Within the solid areas, there were many capillary-sized vessels (HE 400×).

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Figure 2
Immunohistochemical features of glomus tumor. (A) Vimentin showed a cytoplasmic positivity in all tumor cells (immunoperoxidase, 400´). (B) The totality of the tumor cells and blood vessels were intensely positive for a-SMA (immunoperoxidase, 200×). (C) CD34 highlighted the great vascularization of the lesion showing focal positivity in the tumor cells (arrowheads) (immunoperoxidase, 200×). (D) At high power magnification, strong membranous positivity of tumor cells for CD34, mainly in solid areas, representing approximately a third of the tumor (immunoperoxidase, 400×).

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Figure 3
Immunohistochemical and histochemical features of glomus tumor. (A) Muscle actin (HHF-35) presenting strong positivity in all tumor cells and blood vessels (immunoperoxidase, 200×). (B) Most of the tumor was strongly positive for H-caldesmon, however also presented focal negative areas, principally in the focal nodules of spindle cell proliferations (immunoperoxidase, 200×). (C) Positive reactions for PAS highlighting the basement membrane material. (D) immunohistochemistry for type IV collagen highlighting a network of basement membrane material around cells, showing positivity in a “chicken wire” pattern (C: PAS, 400×; D: immunoperoxidase, 400×).

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Table 1
Immunohistochemical profile of the oral glomus tumor

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Table 2
Cases of oral glomus tumor reported in the English-language literature

Antibody	Clone	Result	Pattern
Pan Cytokeratin	AE1/AE3	Negative	NA
CD138	MI15	Negative	NA
CD34	QBEnd-10	Focally Positive	Membranous, 30% of tumor cells
Vimentin	Vim 3B4	Positive	Cytoplasmic, 100% of tumor cells
S-100	Polyclonal	Negative	NA
a-SMA	1A4	Positive	Cytoplasmic, 100% of tumor cells
Specific-Muscle Actin	HHF-35	Positive	Cytoplasmic, 100% of tumor cells
H-Caldesmon	h-CD	Positive	Cytoplasmic, most tumor cells
Desmin	D33	Negative	NA
Type IV collagen	CIV 22	Positive	Pericellular, most tumor cells

Case	Year	Author	Age	Gender	Location	Symptoms	Size (mm)	Type
1	1954	King ⁸8 King ES. Glomus tumor. Aust N Z J Surg 1954;23:280-295.	32	M	Gingiva	Tenderness	6	Solid
2	1965	Harris and Griffin ⁹9 Harris R, Griffin CJ. Glomus tumor of the periodontal tissues. Aust Dent J1965;10:33-37.	35	F	Periodontium	Pain	5	Mixed
3	1967	Sidhu ¹⁰10 Sidhu SS. Glomus tumor of palate. Indian Dent Assoc1967;39:167-168.	10	F	Hard palate	Unkn†	Unkn	Unkn
4	1976	Charles ¹¹11 Charles NC. Multiple glomus tumors of the face and eyelid. Arch Ophthalmol1976;94:1283-1285.*	17	F	Hard palate	No	Unkn	Glomangioma
5	1979	Sato et al. ¹²12 Sato M, Shirasuna K, Sakuda M, Yanagawa T, Yoshida H, Imai J, et al. Fine structure of a glomus tumor of the tongue and expression of C type virus in its tumor cells. Int J Oral Surg 1979;8:199-204.	29	M	Tongue	No	3	Unkn
6	1981	Tajima et al. ¹³13 Tajima Y, Weathers DR, Neville BW, Benoit BW, Pedley DM. Glomus tumor (glomangioma) of the tongue: A light and electron microscopic study. Oral Surg Oral Med Oral Pathol1981;52:288-293.	63	F	Tongue	No	Unkn	Unkn
7	1985	Saku et al. ¹⁴14 Saku T, Okabe H, Matsutani K, Sasaki M. Glomus tumor of the cheek: An immunohistochemical demonstration of actin and myosin. Oral Surg Oral Med Oral Pathol1985;60:65-71.	45	M	Buccal mucosa	No	45	Solid
8	1986	Ficarra et al. ¹⁵15 Ficarra G, Merrell PW, Johnston WH, Hansen LS. Intraoral solitary glomus tumor (glomangioma): Case report and literature review. Oral Surg Oral Med Oral Pathol 1986;62:306-311.	51	F	Upper lip (mucosa)	No	20	Glomangioma
9	1986	Moody et al. ¹⁶16 Moody GH, Myskow M, Musgrove C. Glomus tumor of the lip. A case report and immunohistochemical study. Oral Surg Oral Med Oral Pathol1986;62:312-318.	65	F	Upper lip	No	10	Solid
10	1987	Stajcic and Bojic ¹⁷17 Stajcic Z, Bojic P. Intraoral glomus tumour. A case report. J Craniomaxillofac Surg1987;15:376-378.	55	M	Tongue	Unkn	Unkn	Unkn
11	1992	Geraghty et al. ¹⁸18 Geraghty JM, Thomas RW, Robertson JM, Blundell JW. Glomus tumour of the palate: Case report and review of the literature. Br J Oral Maxillofac Surg 1992;30:398-400.	71	M	Hard palate	No	15	Solid
12	1995	Kusama et al. ¹⁹19 Kusama K, Chu L, Kidokoro Y, Kouzu M, Uehara T, Honda M, et al. Glomus tumor of the upper lip. J Nihon Univ Sch Dent1995;37:97-101.	57	M	Upper lip	Tenderness	Unkn	Solid
13	1996	Savaci et al. ²⁰20 Savaci N, Emiroglu M, Gumren M, Gungor S. A rare case of glomus tumour; buccal localization. Br J Oral Maxillofac Surg1996;34:199-200.	55	F	Buccal mucosa	Pain	10	Glomangioma
14	1997	Sakashita et al. ²¹21 Sakashita H, Miyata M, Nagao K. Glomus tumor in the upper lip. A case report. Int J Oral Maxillofac Surg1997;26:301-302.	54	M	Upper lip (mucosa)	No	12	Solid
15	2000	Yu et al. ²²22 Yu HJ, Kwon SJ, Bahn JY, Park JM, Park YW. Localized multiple glomus tumors of the face and oral mucosa. J Dermatol2000;27:211-213.*	54	F	Face, lower lip, buccal mucosa	No	Unkn	Glomangioma
16	2001	Kessaris et al. ²³23. Kessaris P, Klimis T, Zanakis S. Glomus tumor of the hard palate: Case report and review. Br J Oral Maxillofac Surg2001;39:478-479.	46	F	Hard palate	No	18	Solid
17	2004	Rallis et al. ²⁴24 Rallis G, Komis C, Mahera H. Glomus tumor: a rare location in the upper lip. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:327-336.	85	F	Upper lip (mucosa)	Pain	13	Solid
18	2005	Lanza et al. ²⁵25 Lanza A, Moscariello A, Villani R, Colella G. Glomus tumor of the lower lip. A case report. Minerva Stomatol 2005;54:687-690.	65	M	Lower lip	Unkn	Unkn	Unkn
19	2008	Ide et al. ²2 Ide F, Mishima K, Yamada H, Saito I, Horie N, Shimoyama T, et al. Perivascular myoid tumors of the oral region: a clinicopathologic re-evaluation of 35 cases. J Oral Pathol Med2008;37:43-49.	57	M	Upper lip	Unkn	8	Solid
20	2008	Ide et al. ²2 Ide F, Mishima K, Yamada H, Saito I, Horie N, Shimoyama T, et al. Perivascular myoid tumors of the oral region: a clinicopathologic re-evaluation of 35 cases. J Oral Pathol Med2008;37:43-49.	54	M	Upper lip	Unkn	12	Solid
21	2010	Boros et al. ³3 Boros AL, Davis JP, Sedghizadeh PP, Yamashita DD. Glomus tumor: report of a rare case affecting the oral cavity and review of the literature. J Oral Maxillofac Surg 2010;68:2329-2334.	34	M	Lower lip (mucosa)	No	15	Unkn
22	2010	Dérand et al. ²⁶26. Dérand P, Warfvinge G, Thor A. Glomangioma: a case presentation. J Oral Maxillofac Surg 2010;68:204-207.	11	F	Lower lip (vermilion)	No	3	Glomangioma
23	2018	Vasconcelos et al. ²⁷27 Vasconcelos ACU, Loyola AM, Gomes APN, de Araújo VC, Tarquínio SBC, Silveira FM, et al. A symptomatic swelling of the upper lip. Oral Surg Oral Med Oral Pathol Oral Radiol2018;125:107-111.	67	F	Upper lip (mucosa)	Pain	10	Solid
24	2018	Current case	51	F	Upper lip (mucosa)	Pain	10	Solid

[1] Correspondence: Danyel Elias da Cruz Perez, 4ª Travessa Professor Artur de Sá, s/n, Cidade Universitária, 50740-521 Recife, PE, Brazil. Tel. +55-81-2126-8342. e-mail: danyel.perez@ufpe.br

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Glomus Tumor of the Oral Cavity: Report of a Rare Case and Literature Review

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