Les tumeurs glomiques de la region ungueale : A propos d'une serie de 55 patients

PURPOSE OF THE STUDY: Glomus tumors are infrequent in the hand. We have review 55 cases, localized in the nail area to discuss their diagnosis and surgical approach. MATERIAL AND METHODS: Out of 80 glomus tumors of the hand seen in two hand units, 55 were located around the nail area, 33 in the nail bed area, 8 at the nail root and 14 laterally. The population was predominantly female (42 cases) and the mean age 43 years. The mean delay before presentation was 37 months. Pain was the main symptom (97 per cent) increased by trauma and cold. A blue spot was visible in 15 cases and diagnosis was performed on clinical ground in all cases except two. A notch was present on X-ray in 16 cases. A prospective study with MRI allow a diagnosis in 18 of 21 cases. All tumors were removed through a lateral approach elevating the nail complex and confirmed histologically. RESULTS: The diagnosis was per-operatively confirmed in 53 cases and performed in one case. The last case of supposed hemangioma was modified at histological examination. No case of nail dystrophy (not existing pre-operatively) or residual pain was seen at the 81 months of follow up. Seven recurrences were observed, 4 of them having been operated initially in our units. DISCUSSION: Clinical diagnosis could be performed on clinical grounds. MRI is to be reserved to recurrences or multi-operated patients. Risk of recurrence has to be mentioned pre-operatively to the patient. CONCLUSION: Lateral approach with nail complex elevation is safe, allowing excision of the tumor without nail dystrophy.Cinquante cinq tumeurs glomiques p\ue9ri-ungu\ue9ales, confirm\ue9es histologiquement ont \ue9t\ue9 revues r\ue9trospectivement avec un recul moyen de 81 mois. Le diagnostic avait \ue9t\ue9 fait cliniquement dans 53 cas, devant une douleur exacerb\ue9e au choc et au froid, \ue9licit\ue9e avec une pointe de crayon et am\ue9lior\ue9e par gonflement d'un garrot brachial. Dans 2 cas le diagnostic d'h\ue9mangiome a \ue9t\ue9 fait et redress\ue9 \ue0 l'intervention dans un cas. L'IRM a \ue9t\ue9 \ue9tudi\ue9e prospectivement et a conduit au diagnostic 18 fois sur 21. Nous la r\ue9servons cependant aux cas r\ue9cidiv\ue9s ou multi-op\ue9r\ue9s. Toutes les tumeurs (sauf les deux pseudo-h\ue9mangiomes) ont \ue9t\ue9 abord\ue9es par voie lat\ue9ro-ungu\ue9ale. Aucune dystrophie ungu\ue9ale n'est \ue0 imputer \ue0 cette voie d'abord. Sept r\ue9cidives ont \ue9t\ue9 observ\ue9es et doivent conduire \ue0 informer les patients en pr\ue9-op\ue9ratoire de cette complication rarement mentionn\ue9e