Rare tumour treated due to high clinical acumen of the Plastic Surgeon

-    “Glomus Tumour” diagnoses is challenging as routine investigations are usually within normal limits and Radiographic examination don’t always  reveal any abnormalities

-    Expert surgeon dispels the myth that Plastic Surgery is for Aesthetics alone and makes a strong point for its significance in treating congenital anomalies, cancer and trauma reconstruction amongst others

April 8, 2014, Dubai, UAE……………..50 yr. old Mr. Thomas, a senior executive in an international company was inflicted with severe pain in his right thumb since past few years. The paroxysmal pain that could be elicited at a single tiny point below his thumbnail, even on mild touch could make him cry, such was its severity. He visited several doctors to no avail and in fact even unsuccessfully attempted to have steroid injected, to relieve the pain. Finally, on a business visit to RAK hospital in Ras Al Khaimah, he was referred to Dr. Punam Bijlani, Head of Department of Plastic and Reconstructive surgery “Even as Mr. Thomas, was relating his symptoms I had made a diagnosis.” I told him there was a high suspicion of a glomus tumor. 

A “Glomus Tumour” is a rare benign vascular tumor of the fingers (and other places). It accounts only for a very small percentage of hand tumours. This benign tumour causes considerable morbidity to the patient because of the usual delay in diagnosis who are sometimes thought to be malingering. History & careful physical examination helps to narrow down the differential diagnosis. Although the classic triad of severe paroxysmal pain, temperature sensitivity, and point tenderness exists, these may be in varying proportions and some of them may be absent. Many of these tumors are so tiny that they cannot be seen or palpated and sometimes even missed radiologically. A high clinical suspicion is important. 

Plain radiographs mostly will be normal. Bony erosions usually occur in later stages of the disease. MRI can be useful; however some of these growths are too small and may not be picked up.  Treat the patient, not the Xray. ~James M. Hunter “ Of course not every burning sensation is caused by glomus tumors which as said afore are a very uncommon variety but it’s something to keep at the back of our mind for what the mind does not know the eye cannot see. “The tumor was surgically excised and relief is complete. The offending tumor was only 3mm in size! 

“In the world of technology, we cannot leave behind the value of clinical diagnosis and tacit knowledge for there is no substitution for wisdom that grey hair provide.”

“Further the much-favored opinion that plastic surgery is about aesthetics alone needs to be dispelled. Plastic surgery is one of the most ancient branches of medicine. Congenital anomalies, hand surgery, cancer reconstruction, trauma reconstruction and recalcitrant wounds amongst others, all belong to the purview of plastic surgeons. Reducing plastic surgery to an aesthetic resource alone is as much a disservice to the faculty as it is to society” added Dr. Bijlani.