Dear Sir, Glomus tumour usually occurs in the soft tissue, but very rarely in the bone. We report a case of an intraosseous glomus tumour with severe pain at rest. A 30-year-old man presented with a 7 year history of progressive right index finger pain. The pain gradually increased in severity, occurring at night as well as at rest with marked tenderness over the distal phalanx. There was no swelling or erythema, the nail was not discoloured or deformed, but the affected area became so tender that the patient was preoccupied with the protection of his index finger from any contact. A radiograph revealed a well-circumscribed osteolytic lesion in the distal phalanx (Fig 1) without a sclerotic border and with normal dorsal or palmar cortices. MRI confirmed an intraosseous space-occupying lesion with low signal intensity on T1-weighted image and high signal intensity on T2-weighted images, with no extraosseous involvement. These findings suggested an intraosseous glomus tumour which was excised through a fish-mouth incision over the finger tip. Subcutaneous soft tissue on the palmar side of the distal phalanx was normal as was the surface of the distal phalanx (Fig 2). Through a window in the palmar cortex of the distal phalanx we curetted the lesion, and the residual defect was filled with artificial bone graft. Histopathology demonstrated prominent vascular structures with perivascular nests of glomus cells. At present, 6 months after surgery, the patient has no pain at rest or at night.
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