Glomangiosarcoma arising from traumatic lesion in the elbow

Glomangiosarcoma arising from traumatic lesion in the elbow Dear Editor, Glomus Tumors (GTs) originate from the glomus body, an arteriovenous anastomosis located in the reticular dermis, 1 and are categorized into benign, uncertain behavior, and Malignant Forms (MGTs) based on clinicopathological features. 2MGTs, constituting less than 1% of cases, exhibit aggressive local invasion, a tendency for recurrence after excision, and occasional distant metastasis. 1,3MGTs are further subclassified into locally infiltrative GTs, Glomangiosarcoma (GS) arising from benign glomus tumors, and de novo GS. 1,4,5 We present the case of a female patient, 53 years old, with a medical history of knee osteoarthritis, glucose intolerance, obesity, asthma, and hypothyroidism.The patient reported a sharp accident with glass on the outside of the right forearm, evolving with intense neuropathic pain during the first year.Two years later, she reported increased volume in this area, very sensitive to palpation and associated with spontaneous hemorrhage.The physical examination showed a grayish-brown 10 6 cm well-demarcated, firm, tender, and pulsatile multilobed tumor with a violaceous hue, on the extensor surface of the right forearm (Fig. 1A---B).Doppler study showed a mass characterized by a high arterial density that invaded the cutaneous and subcutaneous tissue up to the superficial fascia.An incisional biopsy revealed a glomangiosarcoma.PET scan reveals no distant dissemination.Tumor was excised with 3 cm margins up to the depth of the underlying muscular fascia and with axillary lymph node dissection.Histopathology showed a well-circumscribed dermal and hypodermal tumor composed of cells with eosinophilic cytoplasm, pleomorphic nuclei, prominent nucleoli, atypical mitotic figures, and high mitotic rate (9 mitotic figures/10 HPF) (Fig. 2A-B).Immunohistochemistry was positive for smooth muscle actin