Metachronous Multifocal Extradigital Glomus Tumor of Lower Extremity: A Case Report and Literature Review

The glomus tumor (GT) is a rare benign neoplasm, generally located in the subungual region of the distal phalanx of the fingers as a single nodule. While approximately 90% of digital GTs are correctly diagnosed (pain, cold sensitivity, and point tenderness), extradigital forms often present with silent or atypical features, complicating diagnosis. The treatment of choice is surgical excision, associated with low recurrence rates. In October 2022, a 64-year-old man presented with a painful, palpable mass in the distal third of the right femur. Magnetic resonance and computed tomography revealed a solid lesion involving the distal third of the femur. A needle biopsy confirmed the diagnosis of GT with hemangiopericytoma-like features. In January 2023, surgical excision was performed, and histology confirmed the diagnosis. The patient had a significant oncologic history: In 1994, he underwent wide resection and adjuvant chemotherapy for a high-grade undifferentiated sarcoma of the right thigh. In November 2012, he reported a painful mass in the right ankle, and excisional biopsy with immunohistochemistry led to a diagnosis of multifocal GT. At his last follow-up in November 2025, he was in good general health under oncologic surveillance. We conducted a search on PubMed and Scopus using the keywords "extra digital glomus tumor" and included articles reporting extra digital GTs of the lower limb. The literature review identified 143 patients with extradigital GT with lower limb involvement. This case represents a rare presentation because of its unusual lower limb location, with lesions in the ankle in 2012 and the femur in 2022. We report a rare case of a late metachronous extradigital GT of the lower limb in an unusual anatomical site.