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Immunohistochemical Demonstration of Cyclooxygenase-2 in Glomus Tumors
Takaji Yanai, MD, PhD1; Toshikazu Tanaka, MD, PhD1; Takeshi Ogawa, MD, PhD1
1 Department of Orthopaedic Surgery, Kikkoman General Hospital, 100 Miyazaki, Noda, Chiba 278-0005, Japan. E-mail address for T. Yanai: yanai@earth.ocn.ne.jp. E-mail address for T. Tanaka: tanaka1041@msn.com. E-mail address for T. Ogawa: oga-take@pg7.so-net.ne.jp
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Investigation performed at the Department of Orthopaedic Surgery, Kikkoman General Hospital, Chiba, Japan

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Apr 17;95(8):725-728. doi: 10.2106/JBJS.L.00341
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Glomus tumors are benign hamartomas that account for 1% to 5% of all soft-tissue tumors of the hand. Painful spasms radiating from the lesion are typical clinical signs. As the pain production mechanism is unclear, we evaluated S100 protein, substance P, and cyclooxygenase-2 expression by immunohistochemistry in glomus tumor samples.


Eight solitary glomus tumors were surgically excised and confirmed histologically by an experienced pathologist. Paraffin-embedded tissues were prepared for immunohistochemistry. The sections were stained with separate polyclonal antibodies for S100, substance P, and cyclooxygenase-2. In three of the tumors, we measured the prostaglandin E2 concentrations.


All samples were positive for S100 protein and cyclooxygenase-2.Substance P was found in five of the eight samples. High prostaglandin-E2 concentrations were seen in all three samples tested.


Cyclooxygenase-2-immunoreactive cells are present in solitary glomus tumors. Since cyclooxygenase-2 produces prostaglandin E2, which is thought to be a strong vasodilator, the pain could be caused by vasodilation in the glomus tumor, with increased intracapsular pressure.

Clinical Relevance: 

Clinically, non-steroidal anti-inflammatory drugs that block prostaglandin production may control glomus tumor pain. However, considering the possible medication side effects, operative management remains the treatment of choice.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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