足部脈絡球腫瘤（Glomus tumor）之超音波診斷——一例報告

Ultrasonographic Diagnosis of a Glomus Tumor in the Foot- Report of A Case

近幾年來，高解析度超音波檢查已逐漸廣泛地運用來檢查表淺軟組織腫瘤，特別是位於四肢肌肉骨骼系統的腫瘤。它是一種非侵襲性、即時性、動態、便宜而且迅速的檢查；並且可以在術前區別腫瘤的特性、估算大小和精確地定位腫瘤的三度空間位置以及與鄰近組織的相對關係，因此對於手術探查的助益甚大。本文報告的病例是一位50歲女性，由於右足第二腳趾的趾甲內側長期劇烈疼痛而四處求醫，卻仍無法獲得正確的診斷與有效的治療，最後經轉介至骨科求診。高解析度超音波檢查發現一界線明顯、形狀為卵圓形的低回音（hypoechoic）實體性（solid）腫瘤，配合臨床資料臆診為脈絡球腫瘤。以外科手術將腫瘤切除後，病理切片檢查證實為脈絡球腫瘤。目前其健康情況及生活品質得到明顯改善，病患非常滿意。高解析度超音波雖然無法精確地診斷腫瘤的病理變化，但它可以分出水囊性（cystic）及實體性腫瘤，並配合腫瘤的位置、大小、血流分佈及邊緣情況，應可幫助臨床上對軟組織腫瘤的診斷。本文就脈絡球腫瘤在超音波影像檢查上的表現做一相關探討，以做為臨床醫師在診斷及治療上的參考。

Glomus tumors, first described by Wood in 1812, are rare, benign hamartomas arising from neuromyoarterial glomus bodies, most commonly in the hand. Aching pain, exquisite tenderness and temperature sensitivity are the classic triad of symptoms of a glomus tumor. This triad is the key to diagnosis, but an atypical anatomic site and the usually small size of the tumor may make the diagnosis difficult. Patients with extremity pain caused by a glomus tumor frquently remain undiagnosed for many years. We reported a case of a 50 year-old woman with increasing right second toe pain over a period of ten years, in whom the diagnosis of glomus tumor was made using ultrasonography, thus enabling complete surgical excision and total relief of pain. In recent years, high-resolution ultrasonography was more frequently used to examine superficial soft-tissue musses. Use of ultrasonography discloses a reliable diagnosis of the cystic or solid nature of soft-tissue lesions, an accurate estimation of the volume, and precise three-dimensional localization of the abnormality. In addition, its cost-effectiveness and greater availability made it more popular. Assessment of anatomic relationships between the lesions to the surrounding structures by real-time ultrasonography also aids in the surgical approach. Therefore, it is a good tool not only in the diagnosis but providing a better basis for treatment. Here, we also discussed the symptoms, signs, diagnosis and treatment of glomus tumor. As what we try to emphasize, ultrasound examination is essential for the early diagnosis of soft tissue tumors and an early and accurate diagnosis will prevent unnecessary procedures.