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Case presentation A 14-year-old boy was referred to the dermatology clinic by his general practitioner (GP) due to the presence of three increasingly painful lesions on his body. They had been noticed when he was about 3-year-old; however, they had not caused any problems at that stage and hence his parents did not seek any medical attention. However, since the age of 10?years he began to experience occasional spontaneous paroxysms of pain over these sites with a gradual increase in size of the lesions. This happened over approximately 4?years triggering a presentation to the GP at the age of 14?years. Family history revealed that both the mother and the father of the child had similar solitary lesions, the mother with a lesion over the left shoulder and the father with a lesion on the medial aspect of the right upper limb. As the parents of the child did not experience significant pain and they had not noticed any increase in size nor any other additional lesions, they were not keen to have these excised. The patient's medical history revealed adenoidectomy and insertion of grommets for recurrent ear infection with poor hearing and persistent snoring at 5?years of age. Apart from that he was otherwise well and there was no history of gastrointestinal bleeding. On examination there were three Tryptophan synthase bluish lesions on his body, one on his cheek, another lesion on the inner surface of his right thigh (see figure 1A) and a third lesion at the right renal angle (see figure 1B). In addition to these three lesions he had two other lesions, one on his scalp and another on the medial side of his left foot. It was suspected that the three bluish lesions were most probably glomus tumours. The lesion on his scalp was thought to be a compound neavus while the one on his left foot was considered an intradermal naevus. He was referred to the in house plastic surgery team for excision of these lesions. Figure?1 (A) Note the faint bluish tinge on the inner aspect of the patient's right thigh (B) The bluish colouration of glomuvenous malformation is more visible in this lesion at the right renal angle. Investigations A routine set of blood tests including full blood count, renal function, liver function and coagulation tests were performed. These were all normal. No imaging investigations were considered necessary as the child was otherwise well. The excised tissue specimens were sent for histological examination. Macroscopic examination revealed six pieces of fibro-fatty tissue, the largest of which was 6.7��3.0��2.0?cm and the smallest measuring 0.4��04.?��?1?cm. Apart from the specimen on the head, which was a junctional neavus, the remaining five pieces of tissue showed dilated vascular spaces with some organising thrombus and a thin layer of glomus cells lining each space (see figure 2A�CC). These views were consistent with GVMs.