Primary Chest Wall Glomus Tumor Resected by Video-Assisted Thoracoscopic Surgery: A Case Report with 10-Year Follow-up.

Abstract

Introduction: Glomus tumors are rare perivascular neoplasms that typically occur in the distal extremities. Their occurrence in the chest wall is extremely rare, with only 13 cases previously reported in the English literature. Herein, we report a unique case of a primary chest wall glomus tumor in a patient who presented with severe, rapidly worsening back pain, underwent ¹⁸F-fluorodeoxyglucose-PET/CT (FDG-PET/CT) evaluation, and experienced complete pain resolution following thoracoscopic resection.

Case presentation: A 65-year-old man presented to our emergency department with a 1-month history of progressively worsening right posterior back pain. Contrast-enhanced CT revealed a 20 × 13-mm well-enhanced oval mass in the right posterior chest wall at the level of the ninth rib. MRI demonstrated heterogeneous intensity on T2-weighted images. FDG-PET/CT showed low tumor uptake with a maximum standardized uptake value (SUVmax) of 2.2. This finding was considered adjunctive metabolic information that did not strongly suggest a highly aggressive malignancy; however, it was insufficient to exclude malignancy or establish a definitive diagnosis. To achieve a definitive diagnosis and alleviate the severe pain, surgical resection was performed via 4-port video-assisted thoracoscopic surgery (VATS). The tumor was completely excised with clear margins. Histopathological and immunohistochemical analyses confirmed the diagnosis of a benign glomus tumor, with diffuse positivity for smooth muscle actin (SMA) and a Ki-67 labeling index of less than 1%. The patient's severe back pain completely resolved immediately after surgery, and he remained completely asymptomatic with no evidence of recurrence at the 10-year follow-up.

Conclusions: Although exceedingly rare, glomus tumors should be included in the differential diagnosis of painful chest wall tumors. FDG-PET/CT may provide adjunctive information regarding metabolic activity during preoperative assessment; however, its findings should be interpreted cautiously and cannot replace histopathological evaluation. To the best of our knowledge, this is the first reported case of a chest wall glomus tumor evaluated with FDG-PET/CT. Complete surgical resection remains essential for definitive diagnosis and symptom relief, and minimally invasive resection via VATS may be an effective approach when complete resection is feasible.