Implications of Glomus Tumor Pathology and Pain Mechanism for Surgical Treatment

Glomus tumor is a rare, benign vascular neoplasm arising from the glomus body, most frequently located in subungual and fingertip regions. Despite its small size, it often causes severe paroxysmal pain and cold sensitivity, posing diagnostic and therapeutic challenges. This review summarizes current understanding of its pathological characteristics, pain mechanisms, immunohistochemical features, and surgical management. The pain arising from glomus tumors is associated with an abundance of unmyelinated nerve fibers and bioactive substances such as substance P, histamine, and cyclooxygenase-2 (COX-2), which mediate neurogenic inflammation and mechanical stimulation. Immunohistochemical analyses of the glomus tumor typically reveal positive expression of alpha-smooth muscle actin (α-SMA), muscle-specific actin (MSA), high-molecular-weight caldesmon (h-caldesmon), and vimentin, which support smooth muscle differentiation, while genetic alterations such as neurogenic locus notch homolog protein 2 (NOTCH2) fusion and alpha-thalassemia mental retardation syndrome X-linked (ATRX) deletion have been linked to tumorigenesis and malignant transformation. Microscope-assisted excision remains the gold-standard approach for treatment, achieving precise tumor removal with low recurrence and minimal postoperative nail deformity. Radiofrequency ablation emerges as a minimally invasive alternative with satisfactory long-term control for patients with high surgical risk or recurrence. In conclusion, integrating molecular insights with minimally invasive technologies holds significant promise for optimizing individualized management and advancing patient outcomes.