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Гломусная ангиома: серия наблюдений и обзор литературы

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Гломусные опухоли обычно возникают в областях, богатых гломусными телами, таких как подногтевые области пальцев или глубокая дерма ладони, запястья и предплечье, однако возможна их локализация и в глубоко расположенных висцеральных местах по всему телу, включая легкие, желудок, поджелудочную железу, печень, желудочно-кишечный и мочеполовой тракты. Предполагается, что они произошли от модифицированных гладкомышечных клеток нейромиоартериального гломуса, обычно называемого гломусным телом, функцией которого является регулирование температуры посредством артериовенозного шунтирования крови. Важным в течении патологического процесса для этих опухолей являются болевые ощущения, сохраняющиеся в течение длительного времени, которое необходимо зачастую для их выявления, и возможность рецидива.Цель исследования: проанализировать и оценить собственные клинические наблюдения гломусной ангиомы различной локализации.Материал и методы. За период с 2004 по 2023 г. в НМИЦ хирургии им. А.В. Вишневского пролечено 6 больных с морфологически верифицированным диагнозом “гломусная ангиома” (5 женщин и 1 мужчина в возрасте от 23 до 50 лет, средний возраст 34,5 года). Все пациенты были оперированы. Локализация образований: мягкие ткани конечностей – 3, забрюшинное пространство – 2, легкое – 1.Результаты. Срок выявления образования варьировал в пределах от 2 мес до врожденного. Следует отметить, что в 2 из 3 случаев локализации образования в мягких тканях конечностей была врожденной. Гломусные ангиомы мягких тканей конечностей имели размеры от 40,0 ? 28,65 мм до крупного образования, состоящего из множественных очагов размером от 20,0 до 60,0 мм в диаметре, все опухоли были многоузловые. Забрюшинные гломусные опухоли имели достаточно большие размеры (многоузловое образование от 6,0 до 48,0 мм в диаметре и одноузловое многокамерное образование полициклической формы размерами 150,0 ? 100,0 ? 80,0 мм). Образование легкого было одноузловое и имело 12,5 мм диаметре. В подавляющем большинстве случаев (5/6) образования проявляли себя болевыми ощущениями и дискомфортом. Только образование легкого было выявлено случайно при профилактическом осмотре.Приведены ультразвуковые критерии и МСКТ-признаки образований различных локализаций. Результаты сопоставлены с данными литературы.Заключение. Учитывая редкость встречаемости гломусной ангиомы и отсутствие публикаций, касающихся гломусных ангиом мягких тканей конечностей и глубоко расположенных опухолей, в отечественной литературе представленный анализ серии собственных наблюдений позволит повысить информированность клиницистов и диагностов об этих опухолях и, тем, самым, увеличить их выявляемость, что даст возможность провести оперативное вмешательство в более ранние сроки.

Ключевые слова:
гломусная ангиома, распространенность, морфология, диагностика, УЗИ, МСКТ, glomus angioma, prevalence, morphology, diagnostics, ultrasound, MSCT

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Glomus angioma: series of cases and literature review

Glomus tumors usually occur in areas rich in glomus bodies, such as the subungual areas of the fingers or the deep dermis of the palm, wrist, and forearm, but they can also occur in deep visceral sites throughout the body, including the lungs, stomach, pancreas, liver, gastrointestinal and urinary tracts. They are thought to have originated from modified smooth muscle cells of the neuromyoarterial glomus, commonly referred to as the glomus body, whose function is to regulate temperature through arteriovenous shunting of the blood. Important during the pathological process for these tumors are pain that persists for a long time, which is often necessary for their detection and the possibility of relapse.The purpose: to analyze and evaluate our own clinical cases of glomus angioma of various localization.Materials and methods. 6 patients with a morphologically verified diagnosis of glomus angioma (5 women and 1 man aged 23 to 50 years, mean age 34.5 years) were treated at A.V. Vishnevsky National Medical Research Center of Surgery for the period from 2004 to 2023. All patients were operated on. Lesions localization: limbs soft tissues – 3, retroperitoneal space – 2, lung – 1.Results. The term of the lesions detection varied from 2 months to congenital. In 2 of 3 cases of the limbs soft tissues tumors localization they were congenital. Limbs soft tissues glomus tumors: the leions ranged in size from 40.0 ? 28.65 mm to a large lesion, consisting of multiple foci ranging in size from 20.0 to 60.0 mm in diameter, all tumors were multinodular. Retroperitoneal glomus tumors: the lesions were rather large (a multinodular lesion from 6.0 to 48.0 mm in diameter and a single-nodular multi-chamber lesion of a polycyclic form, 150.0 ? 100.0 ? 80.0 mm in size). The lung glomus tumor was single-nodular and had a diameter of 12.5 mm. In the vast majority of cases (5/6), the lesions manifested with the pain and discomfort. Only the lung lesion was detected by chance and during a routine examination.The criteria for ultrasound and MSCT signs of the lesions of various localizations are given. The data are compared with literature data.Conclusion. Given the rarity of glomus angioma and the lack of publications on glomus angiomas of soft tissues of the extremities and deep-seated tumors in the domestic literature, the presented analysis of a series of our own cases will increase the awareness of clinicians and diagnosticians about these tumors and, thereby, increase their detection, which will allow for earlier surgery.

Keywords:
гломусная ангиома, распространенность, морфология, диагностика, УЗИ, МСКТ, glomus angioma, prevalence, morphology, diagnostics, ultrasound, MSCT