Re: A case of 14 glomus tumours involving all digits of both hands

Dear Sir, Multiple glomus tumours are rare and most case reports appear in dermatology journals (Barnes and Estes, 1986; Landthaler et al., 1990; Parsons et al., 1997). A 35 year-old, single man presented to our Hand Unit 15 years ago with multiple bluish periungual lesions (3–5mm in diameter) involving both hands. Similar lesions were also noted in the feet (Fig 1). The lesions were first noted at the age of 15 years and were initially asymptomatic. Clinically, there was only mild point tenderness. There were no other abnormalities and the family history was negative. A clinical diagnosis of multiple glomus tumours was made. Over the last 10 years, the patient has undergone excision of all the hand lesions because of increasing symptoms, but the tumours in the feet have remained asymptomatic. After each of the five surgical procedures, there was complete symptomatic relief with no complications or recurrence. Histopathology examination confirmed the clinical diagnosis of multiple glomus tumours. Love’s test (point tenderness) remains to be the most commonly used clinical test for the diagnosis of glomus tumours of the hand. Other clinical tests have been described and include Joseph–Posner’s test, the cold water immersion test, Hildreth’s test and the transillumination test (Al-Qattan et al., 2005). In addition, plain radiography (to evaluate bone erosion), ultrasonography and MRI may be used pre-operatively, and the latter two have been recommended for the assessment of multiple glomus tumours. These investigations were not done in our patient since the clinical diagnosis was obvious. The basic differences between single and multiple glomus tumours are shown in Table 1. Our case has several unique features when compared to other reported cases of multiple glomus tumours. These include the negative family history, the presence of all the lesions within the digits and the small tumour size. Furthermore, our patient is a native Arab and most reported cases of multiple glomus tumours are from Northern Europe, particularly Scotland. Rudolph (1993) reported on a patient from Scotland with a fivegeneration history of multiple glomus tumours and suspected that several of the published reports deal with branches of the same family. An interesting historical note was that the family tree of affected persons started with a woman who married John Merson. His son George made catgut sutures in Scotland in the early 1900s. The company was later purchased by Johnson and Johnson and was renamed Ethicon, Ltd. Merson’s name is memorised in ‘‘Mersiline’’ sutures.