a 71-year - old man visited our pain clinic presenting with a 3-year history of abdominal pain . the nature of pain was constant , superficial throbbing and lancinating and sometimes diffusely radiated with visual analogue scale ( vas ) score 70 - 80 of 100 . it was more severe at night and early morning , thus resulting in sleep disturbance . the patient had no specific medical history except pain killers due to the pain described above . previous treatment included non - steroidal anti - inflammatory drugs ( nsaids ) , opioids , local heating , bracing , epidural block , peripheral block and local anesthetic infiltrations , and had no effect . imaging studies including x - ray , abdominal ultrasonography and magnetic resonance imaging ( mri ) showed non - specific findings . he was taking anticonvulsant medications under the diagnosis of post herpetic neuralgia ( phn ) at the hospital he had previously visited . neurological examination and no gastroenterological problem could be found as the cause of chronic abdominal pain after consultation to the department of internal medicine . physical examination was characterized by exquisite pressure tenderness over the painful area on the right lower quadrant . a careful examination of ultrasonography over the painful area showed a 4.7  3.6 mm small nodular lesion with increased focal blood flow , and a well - circumferenced hypoechoic character . 1 ) . we did not think of this cyst as the origin of the patient 's pain . local anesthetic injections around the cyst decreased his pain to some degrees ( vas score 60 of 100 ) . nevertheless , injections into the cyst developed more severe pain up to vas score 100 . in spite of repetitive treatment , his symptoms did not improve . with the possibility that this cyst could be the source of his pain , we transferred the patient to the department of surgery for a detailed evaluation . a general surgeon carefully followed up for about 5 months with conservative treatment including steroid and painkillers under the suspicion of thrombophlebitis . however , he did not seem to get any better , maintaining a vas score of 80 out of 100 . finally the surgeon decided to proceed with diagnostic excision . it was confirmed as a 14  10  7 mm glomus tumor by histologic examination ( fig . the excision was completely curative , and the patient was free of pain , with a vas score of 0 out of 100 without any medication . glomus tumors were first described clinically by wood in 1812 as " painful subcutaneous tubercles " . although they can be found anywhere in the body , about 75% of them are found in the hands . thus glomus tumors were usually recognized as a cause of digit pain , especially in the subungual region . tumors may not be palpable because they are very small , often 3 to 4 mm in average size and sometimes deeply located in the tissue . therefore , diagnosis of extradigit glomus tumors is commonly delayed or even missed . in a previous report , , consultations with an average of 2.5 physicians were routinely done until an exact diagnosis was made . the classic diagnostic triads are known as spontaneous pain , pressure tenderness , and cold hypersensitivity . when the tumor can be detected by physical examination , there is a reddish or bluish discoloration of the skin , or contact produces a sharp pain that radiates diffusely . the diagnosis of glomus tumors is strengthened if inflation of a blood pressure cuff to above systolic pressure completely reduces pain after several seconds . another test is love 's test that consists of severe local pressure tenderness elicited when applying pressure with a blunt point to the patient 's painful area . clinical differential diagnosis includes neuroma , raynaud 's phenomenon , infection , gout , peripheral neuropathy and radiculopathy . on the histological aspect , hemangiopericytoma , hemangioma , angiomyoma , neurilemoma , and many other hamartomas are under differential diagnosis . in our case , the reason for conservative therapy by the general surgeon was aspiration cytology results only showed a blood clot and thrombophlebitis also considered to be one of the causes of pain , including above differential diagnostic diseases . mri has known to be the most sensitive imaging modality for diagnosis of glomus tumors but specificity is limited to about 50% . radiography , angiography , thermography , ultrasonography and scintigraphy have been used to diagnose glomus tumors but with limited diagnostic value . in our case , due to the chronic abdominal pain , differential diagnosis mentioned above such as gastrointestinal disorders also , the patient did not satisfy the diagnostic triad in that and no discoloration could be found . however , the love 's test was positive at physical examination . to evaluate the characteristics of the observed cystic lesion , we injected local anesthetics around and into the cystic lesion . however , injection into the lesion provoked more severe pain with strong resistance , respectively . glomus tumors cells have properties that are similar to smooth muscle cells , accounting for their contractility which is very sensitive to pain . addition to symptom triads , love 's test and " injection local anesthetics " , the final diagnosis was made with excisional biopsy . early diagnosis of glomus tumors , especially in rare locations , would help patients from suffering pain for a long time and conducting unnecessary procedures . pain physicians should include glomus tumors in the differential diagnosis of any localized tenderness associated with extreme neuropathic pain . excisional biopsy should be done to make a confirmation diagnosis when a suspicious lesion is found during examinations . this case raises the awareness of atypical causes of regional pain syndromes related to glomus tumors .
glomus tumors are small vascular tumors that are usually benign and rarely occur . 
 they originate from glomus bodies and present in the reticular dermis . 
 they are clinically distinguished by their small size and their ability to cause extreme pain . 
 most of these tumors are subungually located . 
 however , atypical locations of the tumors sometimes cause misdiagnosis , particularly when the lesion is rarely reported . therefore , we report a case of glomus tumor which presented with chronic abdominal pain , found in the abdominal wall that has never been reported before .