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Auerbach A, Girton M, Aguilera N. Controversies in the Spleen: Histiocytic, Dendritic, and Stromal Cell Lesions. Surg Pathol Clin 2023; 16:385-400. [PMID: 37149364 DOI: 10.1016/j.path.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Histiocytic, dendritic, and stromal cell lesions that occur in the spleen are challenging diagnostically, not well studied due to their rarity, and therefore somewhat controversial. New techniques for obtaining tissue samples also create challenges as splenectomy is no longer common and needle biopsy does not afford the same opportunity for examination of tissue. Characteristic primary splenic histiocytic, dendritic, and stromal cell lesions are presented in this paper with new molecular genetic findings in some entities that help differentiate these lesions from those occurring in non-splenic sites, such as soft tissue, and identify possible molecular markers for diagnosis.
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Affiliation(s)
| | - Mark Girton
- University of Virginia Health System, Charlottesville, VA, USA
| | - Nadine Aguilera
- University of Virginia Health System, Charlottesville, VA, USA.
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Papatheodorou P, Taliadoros A, Thrasyvoulou C, Tsironis G. Sclerosing angiomatoid nodular transformation of the spleen: a case report. BMJ Case Rep 2021; 14:e246993. [PMID: 34949583 PMCID: PMC8704970 DOI: 10.1136/bcr-2021-246993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/04/2022] Open
Abstract
Sclerosing angiomatoid nodular transformation (SANT) of the spleen is an uncommon primary benign condition with specific histopathological characteristics. The majority of the patients are usually asymptomatic and present for treatment after an incidental finding on a routine abdominal imaging. The differential diagnosis includes other benign tumours, as well as primary malignancy or metastases of unknown origin. We report a 55-year-old woman who was presented to the surgical team of our hospital for splenectomy after the investigation of an incidental splenic lesion led to the diagnosis of SANT. The pathology report of the specimen repeated the initial diagnosis. The patient has not yet presented any complication or recurrence of the disease 8 months after the operation. From such infrequent cases, the most valuable conclusion which can be yielded is that the more the number of patients reported, the more the knowledge about the disease is broadened.
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Affiliation(s)
| | | | | | - George Tsironis
- Oncology Department, Nicosia General Hospital, Leukosia, Cyprus
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Ong BS, Thomas R. Sclerosing Angiomatoid Nodular Transformation (SANT): A Rare Splenic Tumor and Unusual Cause of Anemia. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933598. [PMID: 34772906 PMCID: PMC8601013 DOI: 10.12659/ajcr.933598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Patient: Male, 57-year-old
Final Diagnosis: Sclerosing angiomatoid nodular transformation (SANT) of spleen
Symptoms: Anemia
Medication:—
Clinical Procedure: Splenectomy
Specialty: Surgery
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Affiliation(s)
- Bee Shan Ong
- Upper Gastrointestinal Surgery, Lyell Mcewin Hospital, Adelaide, South Australia, Australia
| | - Rebecca Thomas
- Upper Gastrointestinal Surgery, Lyell Mcewin Hospital, Adelaide, South Australia, Australia
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Tseng H, Ho CM, Tien YW. Reappraisal of surgical decision-making in patients with splenic sclerosing angiomatoid nodular transformation: Case series and literature review. World J Gastrointest Surg 2021; 13:848-858. [PMID: 34512908 PMCID: PMC8394383 DOI: 10.4240/wjgs.v13.i8.848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many clinicians and surgeons are unfamiliar with the sclerosing angiomatoid nodular transformation (SANT), which is gaining recognition as a benign splenic tumor. We challenge that SANT is rare and whether surgical intervention could be avoided through critical imaging review.
AIM To evaluate the incidence of SANT among splenic tumors and the decision-making process of SANT management.
METHODS Twenty hospitalized patients who underwent splenectomy in 2018 and 2019 in a tertiary university hospital were retrospectively reviewed, and their data on imaging, diagnosis, surgical indications, and courses were recorded. All pathology results were confirmed by pathologist. Discriminative features differentiating SANT from other non-SANT splenic tumors were descriptively analyzed in this case series.
RESULTS Fourteen out of 20 patients who underwent splenectomy had splenic tumors, including 3 SANTs (21% splenic tumors), 6 non-SANT benign lesions (43%), 2 metastatic tumors, and 3 lymphomas. Hypointensity on T2-weighted magnetic resonance imaging (MRI), spoke wheel enhancing pattern in contrasted computed tomography or MRI, and cold spot (low fluorodeoxyglucose uptake) in positron emission tomography (PET) scan helped establish the diagnosis of SANT. Lymphoma, presenting with a hot spot on the PET scan were differentiated from SANT. Surgical indications were reformatted for splenic tumors. Splenectomy need not be performed in patients with typical imaging features of SANT.
CONCLUSION SANT is not a rare disease entity in clinical practice. Splenectomy should not be routinely indicated as the only management option for SANT with typical imaging features.
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Affiliation(s)
- Hao Tseng
- School of Medicine, National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Medical Education, and Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
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Shao H, Lu B, Shen Z, Liu F. Sclerosing Angiomatoid Nodular Transformation of the Spleen: Analysis of Clinical and Pathological Features in Five Cases. Front Surg 2021; 7:609284. [PMID: 33634163 PMCID: PMC7901957 DOI: 10.3389/fsurg.2020.609284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/29/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: We aimed to summarize the clinical and pathological features of sclerosing angiomatoid nodular transformation (SANT) in spleen among five cases. Methods: Five cases (male: 3; female: 2; mean age: 47.6 years) with SANT confirmed by pathological analysis between July 2010 and November 2019 in our hospital were included in this study. The clinical, imaging, and pathological data were analyzed retrospectively. Results: Three patients presented with mild abdominal pain or discomfort, while the other two were symptom free. Two patients received ultrasonography (US), and all patients underwent a computerized tomography (CT) scan in our hospital. The typical “spoke wheel” pattern was seen in two cases, and central calcification was detected in one case on the CT scans. All patients indicated peripheral enhancement around the SANT lesion during the arterial phase. Open or laparoscopic splenectomy was performed for treatment. No patient showed recurrence in the follow-up. The pathological characteristics of our cases were in line with those of previous literatures. Conclusions: Peripheral enhancement around the SANT lesion during the arterial phase should be taken into consideration for the diagnosis of SANT as an imaging sign on CT scans. Special attention should be paid to the splenic integrality during the laparoscopic approach, due to the probability of malignancy and the fragility of the spleen.
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Affiliation(s)
- Huijiang Shao
- Department of Hepatobiliary and Pancreatic Surgery, Department of Pathology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Baochun Lu
- Department of Hepatobiliary and Pancreatic Surgery, Department of Pathology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Zhihong Shen
- Department of Hepatobiliary and Pancreatic Surgery, Department of Pathology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Fang Liu
- Department of Hepatobiliary and Pancreatic Surgery, Department of Pathology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
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Liao J, Wang Z, Li Q, Gou Z, Bai X, Kang H, Shi H, Wang H. CT and MRI features of sclerosing angiomatoid nodular transformation of the spleen: A report of 18 patients with pathologic correlation. Diagn Interv Imaging 2021; 102:389-396. [PMID: 33495124 DOI: 10.1016/j.diii.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to describe the computed tomography (CT) and magnetic resonance imaging (MRI) features of sclerosing angiomatoid nodular transformation (SANT) of the spleen and correlate imaging features with those obtained at histopathologic analysis. MATERIALS AND METHODS A total of 18 patients (9 men, 9 women; mean age, 42.2±10.7 [standard deviation (SD)] years; range, 23-59 years) with histopathologically confirmed SANT were retrospectively evaluated. The presenting symptoms, gross pathologic changes, and histopathologic and correlative immunohistochemical results were recorded. CT (n=8) and MRI (n=12) features were analyzed by two radiologists and included number, size, shape, boundary, attenuation, signal intensity, and enhancement patterns. RESULTS Seventeen patients (17/18; 94%) had a single SANT without specific clinical symptoms and one patient (1/18; 6%) had multiple SANTs with left-upper-quadrant bloating and pain. The largest lesion diameter exceeded 3cm. On plain CT images, SANTs were slightly hypoattenuating in seven patients (7/8; 88%), isoattenuating in one patient (1/8; 13%), and contained calcification in two patients (2/8; 25%). On T2-weighted MR images, SANTs displayed hypointensity in ten patients (10/12; 83.3%), isointensity in one patient (1/12; 8%) and hyperintensity in one patient (1/12; 8%). On T2-weighted images, stellate or scattered fibrous scars were observed in all patients (12/12; 100%). On diffusion-weighted images, SANTs appeared as heterogenous or homogeneous hypointense in 12 patients (12/12; 100%). Compared to out-of-phase images, SANTs displayed decreased local signal intensity on in-phase images in 12 patients (12/12; 100%). On enhanced CT and MRI images, SANTs had clear boundaries (17/18; 94%), oval (7/18; 39%) or lobular (7/18; 39%) shape, displayed progressive centripetal enhancement (18/18; 100%), spoke-wheel pattern (14/18; 78%), nodular enhancement (11/18; 61%), or delayed enhancement of central fibrous scar (9/18; 50%). CONCLUSIONS SANT of the spleen predominantly manifests as a solid, single, oval or lobular, and well-defined lesion with a fibrous scar and occasional calcification. Typical enhancement characteristics include progressive and centripetal enhancement, spoke-wheel pattern, nodular enhancement, and delayed enhancement of central fibrous scar. Hypointensity on T2- and diffusion-weighted images are due to hemosiderin deposition and fibrous tissue.
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Affiliation(s)
- Jianyong Liao
- Department of Radiology, Daxing Teaching Hospital of Capital Medical University, No. 26 Huangcunxi Street, Daxing District, 102600 Beijing, China
| | - Zhanbo Wang
- Department of Pathology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853 Beijing, China
| | - Qiong Li
- Department of Radiology, Tianjin Nankai Hospital, No. 6 Changjiang Road, Nankai District, 300100 Tianjin, China
| | - Zhenheng Gou
- Department of Radiology, Daxing Teaching Hospital of Capital Medical University, No. 26 Huangcunxi Street, Daxing District, 102600 Beijing, China
| | - Xu Bai
- Department of Radiology, Fifth Medical Center, Chinese PLA General Hospital, No. 100 West Fourth Ring Middle Road, Fengtai District, 100039 Beijing, China
| | - Huanhuan Kang
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853 Beijing, China
| | - Huaiyin Shi
- Department of Pathology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853 Beijing, China
| | - Haiyi Wang
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853 Beijing, China.
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Li SX, Fan YH, Wu H, Lv GY. Sclerosing angiomatoid nodular transformation of the spleen: A case report and literature review. World J Clin Cases 2021; 9:211-217. [PMID: 33511187 PMCID: PMC7809664 DOI: 10.12998/wjcc.v9.i1.211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/17/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sclerosing angiomatoid nodular transformation (SANT) is a rare disease of the spleen. It has unique pathological features and mimics splenic tumor on radiological imaging.
CASE SUMMARY A 47-year-old woman was incidentally found to have a splenic mass on abdominal ultrasound. She had a 10-cm postoperative scar in the lower abdomen due to previous cesarean sections. The patient had a past history of anemia of unknown etiology for 20 years. The patient underwent laparoscopic splenectomy. The postoperative course was uneventful, with a hospital stay of 7 d. The histopathological examination of the spleen revealed SANT. At the 6-mo follow-up, the patient remained disease-free.
CONCLUSION SANT is a rare benign disease mimicking a malignant tumor. A definitive diagnosis can be made only on histopathology.
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Affiliation(s)
- Shu-Xuan Li
- Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ye-Hui Fan
- Department of The First Operation Room, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Hao Wu
- Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Guo-Yue Lv
- Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Idrissa S, Rabattu PY, Sole Cruz E, Robert Y, Piolat C. Sclerosing angiomatoid nodular transformation of the spleen in children: a two-case report of laparoscopic total or partial splenectomy and a literature review. WORLD JOURNAL OF PEDIATRIC SURGERY 2020; 3:e000153. [DOI: 10.1136/wjps-2020-000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/04/2022] Open
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Aziret M, Yılmaz F, Kalpakçı Y, Subaşı Ö, Şentürk A, Karaman K, Ercan M. Sclerosing angiomatoid nodular transformation presenting with thrombocytopenia after laparoscopic splenectomy - Case report and systematic review of 230 patients. Ann Med Surg (Lond) 2020; 60:201-210. [PMID: 33204415 PMCID: PMC7610015 DOI: 10.1016/j.amsu.2020.10.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/18/2020] [Accepted: 10/18/2020] [Indexed: 12/24/2022] Open
Abstract
Background Sclerosing angiomatoid vascular transformation (SANT) is a rare vascular disease of the spleen, which is difficult to diagnose due to its pre-intervention appearance of malignancy. Case Report: An 85-year-old male was transferred to our clinic for thrombocytopenia and splenic mass. A contrast enhanced abdominal CT and MRI showed nodular lesions, the largest 50mm in diameter, and several areas of heterogeneous contrast field involvement in the spleen parenchyma. Laparoscopic splenectomy was performed with normal range of platelet level. The patient's postoperative course was uneventful and he was discharged on the 6th postoperative day. Histopathology revealed SANT. The patient is now in the 18 th month of remission with platelet levels within normal range and with no recurrence. Results Between 2004 and April 2020, a total of 230 SANT patients who underwent laparoscopic or open splenectomy or biopsy were reported in the literature. Most patients were female (52.1%), and the median age was 46 years (9 weeks-85 years). Most patients were asymptomatic (56%). Open splenectomy was performed on 166 patients (72.1%),laparoscopic splenectomy on 35 patients (15.2%) and laparoscopic partial splenectomy on 15 patients (6.5%). The median operation time and spleen weight were 143 minutes (88-213) and 260gr (68-2,720), respectively. Median follow-up time was 12 months (0-166). No recurrence was seen in patients undergoing total splenectomy. Conclusion SANT is an unusual disease of the spleen. In the light of this systematic review, a minimally invasive method for total or partial splenectomy,specifically laparoscopy, can be preferred as the treatment of choice. SANT is a rare, benign vascular disease of the spleen. The correct diagnosis of SANT pre-intervention or preoperatively is a significant for treatment. Laparoscopic splenectomy is curative treatment for SANT.
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Affiliation(s)
- Mehmet Aziret
- Sakarya University Faculty of Medicine, Department of General Surgery Sakarya, Turkey
| | - Fahri Yılmaz
- Sakarya University Faculty of Medicine, Department of Pathology Sakarya, Turkey
| | - Yasin Kalpakçı
- Sakarya University Faculty of Medicine, Department of Hematology Sakarya, Turkey
| | - Özkan Subaşı
- Sakarya University Faculty of Medicine, Department of General Surgery Sakarya, Turkey
| | - Adem Şentürk
- Sakarya University Faculty of Medicine, Department of General Surgery Sakarya, Turkey
| | - Kerem Karaman
- Sakarya University Faculty of Medicine, Department of General Surgery Sakarya, Turkey
| | - Metin Ercan
- Sakarya University Faculty of Medicine, Department of General Surgery Sakarya, Turkey
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