Glomus tumor (glomangioma) is a rare benign slowly growing exquisitely painful tumor constituting about 2% of all hand tumors. It arises from a neuromyoarterial glomus, which is an arteriovenous anastomosis functioning without an intermediary capillary bed. Normal glomus bodies are found in the dermal retinacular layer of the skin and thought to aid in the thermoregulation of skin circulation and to be highly concentrated in the finger tips, particularly beneath the nail bed [1]. Glomus tumors that was described first by Masson in 1942, can occur anywhere in the skin or soft tissue, and the most common site is the finger [3]. The tumor usually presents as a painful, firm, purplish solitary nodule of the extremities, most commonly in the nail bed [2]. Preoperative tumor localization plays crucial role in the surgical treatment of glomus tumor without recurrence. Depending on the clinical triade, provocative clinical tests and MR imaging proper tumor site can be detected with high pre...

Purpose: Glomus tumors account for 1-4% of benign hand tumors. In 65% of cases, it is located in the nail bed. Its rarity makes misdiagnosis problems relatively common. Symptomatology is characterized by the hallmark symptomatic triad. Imaging investigations may guide the diagnosis, but the diagnosis is made by pathological examination doubled by immunohistochemical (IHC) markers. Patients, Materials and Methods: We studied a group of seven female patients, aged 28 to 56 years. Clinical examination revealed the presence of the characteristic symptomatic triad. Ultrasound imaging tests were performed. Results: Anatomopathological examination made a diagnosis of glomus tumor in all seven cases. IHC staining showed that tumor cells were positive for alpha-smooth muscle actin (α-SMA) and h-caldesmon in all seven cases and negative for cluster of differentiation 34 (CD34) in 72.14%. IHC stainings for p63, S100, cytokeratin (CK) AE1/AE3 were negative in all cases. The clinical diagnosis completed by ultrasonography was histopathologically confirmed in all cases. Conclusions: Although the glomus tumor is a rare lesion, we need to be familiar with it because a diagnostic delay also implies a treatment delay which will lead to amplified suffering and even real disability due to the high-intensity pain in these cases.

Glomus Tumour is an uncommon, painful entity arising from the arterial end of the glomus body. We report an interesting case of chronic severe obscure pain in the finger tips with the complete longitudinal splitting of nail. Love Test (eliciting point tenderness on pressing the swelling with tip of pen) was positive in our case and the patient had increased sensitivity to cold temperature. Hildreth test (disappearance of the pain after application of a tourniquet proximally on the arm in case of glomus tumour) was negative in our case. Colour Doppler helped to diagnose the presence of mass in subungual area. Patient was treated with the excision of the swelling along with nail. Histopathological finding confirmed the diagnosis of the subungual glomus tumour. Longitudinal splitting of the nail due to underlying glomus tumour is a unique presentation which will help in making clinical diagnosis and examining patient of glomus tumour with such presentation on clinical grounds. INTRODUC...

Tumours of the nail apparatus are often the subject of diagnostic dilemma. Until now, no reliable imaging methods have been available to assess these lesions correctly. We report the results of high and very high-resolution magnetic resonance imaging (MRI), which have been correlated with the anatomical findings in 14 cases of nail apparatus pathology, and discuss the possible contribution of MRI to diagnosis. With very high-resolution MRI, accurate analysis of the anatomy of the nail apparatus is possible, and lesions as small as 1 mm can be detected. An expansive process can be excluded when results are negative. Glomus tumour, mucoid pseudocyst, fibrokeratoma, and exostosis can be differentiated because of their different MRI characteristics. This is of importance when the exact nature of a subungual tumour cannot be determined by clinical findings alone. Measurement, determination of the exact localization of the tumour, and the study of its relationship to the other structures, can provide guidance for subsequent surgical procedures. MRI is reliable and accurate in the delineation of lesions, and provides a new tool for the investigation of pathology of the nail apparatus.

Background: Glomus tumors commonly occur in the subungual region of the fingers and toes. They may cause subtle pain and cold intolerance of the involved fingers and toes. Clinical tests(classic triad) including Love's pin test, Hildreth's test and cold sensitivity test are helpful in the diagnosis of lesions. Radiography (X-ray), sonography and magnetic resonance imaging (MRI) can be applied for identification of glomus tumor. Aim and Objectives: We report a case series of glomus tumors of the fingers and toes from a single medical center. The diagnoses and the surgical approaches between Mar. 2002 and Feb. 2013 are described. Materials and Methods: Thirty-four patients diagnosed with glomus tumors at Taichung Veterans General Hospital (TCVGH) during the period from March 2002 to February 2013 were included in this study. Thirty glomus tumors were located in the fingers (88.2%) and four were located in the toes(11.8%). Twenty-three patients (67.6%) were women and eleven patients (32.4 %) were men. The average age of these patients was 41.5 years old(range from 21 to 73 years old). X-ray, sonography or MRI exams were applied when the diagnosis could not be confirmed by history and physical examination. We adopted a transungual approach for excision of tumors, including unilateral eponychium extension or bilateral eponychium extension. In one special case, lateral approach for excision of the tumor was employed. Results: All patients were clinically diagnosed with glomus tumors and excision by transungual approach was performed, except for one in lateral approach was adopted. The pathological diagnoses of glomus tumors were confirmed in all cases. All cases reported pain-free status within a few days post-surgery and returned to normal daily functioning within one week after removal of stitches. The follow-up period was from 94 Treatment of Digital Glomus Tumor 臺灣整形外科醫誌：民國 104 年／24 卷／2 期 half a year to 11 years. Two patients (5.9%) had tumor recurrence, with an average disease-free interval of 6 years. Conclusion: Clinical diagnosis of the glomus tumor can be established by a combination of classic triad and imaging studies. The goal of tumor excision is to reduce damage to the nail bed and germinal matrix and to prevent tumor recurrence. Transungual approach for excision of glomus tumors is a reliable surgical method. (J Taiwan Soc of Plast Surg 2015;24:93～104)

Chamber Tomb burial Chamber, house of Dead, ritual space. Consideration on the Chamber-grave from Popradmatejovce. the tomb of poprad-matejovce from the late 370s aD, its discovery, excavation and later exploration is closely linked to the person of Karol Pieta. The excellent preservation of organic material even in the higher layers of finds as well as the detailed documentation make the tomb a model case for chamber tombs of the late roman period and early migration period for questions concerning the level of meaning of structural aspects, the rites connected with the concept of the afterlife, internal spatial structures of the tombs, find zones and all the detailed processes of tomb construction, procession and burial. thus, the outer burial chamber can be regarded as a general ritual space in which all elements connected with the burial can be located. through an entrance on the east side, the burial public could view all the burial rites materialised in this ritual space as well as the deceased laid out on his bed in the inner chamber. the inner chamber is constructed as a house of the dead with a gabled roof, defining a space exclusively reserved for the laid out dead with his personal grave goods and costume/status elements. the architecture of the inner chamber is clearly based on the element of the domus aeterna from Roman burial contexts. The tomb at Poprad clearly shows an inner zoning. In addition to the zone reserved for the dead within the house of the dead, another space is defined to the south of the house of the dead, in which only objects from the sphere around the funerary banquet and cleaning rituals were found. An important find is the funerary bier, which had been dismantled and deposited on the roof after the mortuary house had been closed. This was certainly used during the procession to the burial site and is a singular find in the Barbaricum. All in all, the grave at Poprad shows indications of rites and ideas of the afterlife that are difficult to decipher because, in contrast to Roman burial rites, written sources are lacking in the Barbaricum of this period.