Glomus tumor of the scrotum: an intraoperative differential diagnostic tip

Glomus tumors are rare, benign neoplasms arising from glomus bodies, primarily located in the subungual region and upper extremities, but uncommonly reported in areas such as the scrotum. Here, we describe a unique case of a glomus tumor of the scrotal skin in a 28-year-old male presenting with a two-year history of a painful, gradually enlarging scrotal nodule. Clinical examination revealed a tender oblong nodule, and dermoscopy suggested a benign neoplasm. Imaging and initial biopsy confirmed the lesion as a possible glomus tumor. Remarkably, during biopsy, the tumor spontaneously and completely "popped out", narrowing the differential diagnosis to glomus tumor, angiolipoma, and epidermoid cyst. Histopathology confirmed the diagnosis of a glomus tumor, showing classic features including thick-walled blood vessels surrounded by smooth muscle actin-positive cells and a pseudocapsule. Postoperative pain resolution supported the clinical diagnosis. This case highlights the importance of considering glomus tumors in the differential diagnosis of painful scrotal lesions, especially when a mass exhibits spontaneous ejection during manipulation. To our knowledge, this is the first reported case of a scrotal glomus tumor in Saudi Arabia.