Hand-assisted laparoscopic splenectomy for sclerosing angiomatoid nodular transformation of the spleen complicated by chronic disseminated intravascular coagulation: a case report

Sclerosing angiomatoid nodular transformation presenting with thrombocytopenia after laparoscopic splenectomy - Case report and systematic review of 230 patients

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.

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SANT is a rare, benign vascular disease of the spleen.

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The correct diagnosis of SANT pre-intervention or preoperatively is a significant for treatment.

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Laparoscopic splenectomy is curative treatment for SANT.

Laparoscopic Splenectomy in a Patient with Sclerosing Angiomatoid Nodular Transformation

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a specific, tumor-forming, non-neoplastic, vascular lesion with few reported cases worldwide. Herein, we describe the case of a patient who underwent laparoscopic splenectomy for SANT. A 47-year-old woman underwent upper gastrointestinal endoscopy for suspected gastric submucosal tumor. Contrast-enhanced abdominal computed tomography revealed the presence of a gradually enhancing lesion in the splenic hilum. Although we suspected splenic fibrotic hamartoma, malignancy could not be ruled out. Therefore, the patient underwent laparoscopic splenectomy, resulting in the histopathological diagnosis of SANT. Although SANT is a benign tumor, it may be difficult to obtain definitive diagnosis using preoperative imaging alone. Because the long-term natural history of SANT is unknown, we believe that splenectomy could be an appropriate technique for the diagnosis and treatment of SANT.

Sclerosing Angiomatoid Nodular Transformation: Laparoscopic Splenectomy as Therapeutic and Diagnostic Approach at the Same Time

Introduction

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular lesion with unknown etiopathogenesis and with definite features of imaging, histopathology, and immunohistochemistry. It was first described by Martel et al. in 2004, and to date, only 151 cases have been reported.

Case Description

We report a case of SANT of the spleen detected in a 66-year-old Caucasian, without comorbidities, presented to our department with epigastric pain. We, also, presented a review of the literature.

Conclusions

SANT is a benign incidentally vascular condition in the majority of cases. The wide age and gender distribution in our review is in accordance with that in previous studies in English literature. In our opinion, splenectomy is the choice treatment because it is at the same time diagnostic and therapeutic in a definitive way.

Laparoscopic splenectomy for sclerosing angiomatoid nodular transformation of the spleen

Sclerosing angiomatoid nodular transformation (SANT) is a rare, benign, proliferative vascular lesion that arises from the splenic red pulp. Most patients with SANT have no clinical symptoms and are discovered incidentally on imaging. There are no definitive radiological signs and a distinction from other splenic diseases, and malignant processes remain difficult. Confirmation of the diagnosis of SANT requires a histological and immunohistochemical evaluation of the resected spleen. Here, we report an unusual case of SANT of the spleen successfully treated with an elective laparoscopic splenectomy (LS). LS is a safe and effective method for diagnosis of SANT.

Sclerosing Angiomatoid Nodular Transformation of the spleen, focal nodular hyperplasia and hemangioma of the liver: A tale of three lesions

Sclerosing Angiomatoid Nodular Transformation (SANT) of the spleen is a benign vascular lesion with peculiar histological features. The pathogenesis of SANT is still largely unknown and variable etiologies have been proposed, including autoimmune, inflammatory, and/or vascular disorders. The present report describes a unique case of splenic SANT, associated with focal nodular hyperplasia and a sclerosing hemangioma of the liver. The clinic-pathological features of such an unusual case are thoroughly illustrated. Its possible pathogenic mechanisms are also briefly addressed.

Sclerosing angiomatoid nodular transformation of the spleen: A case report and literature review

Sclerosing angiomatoid nodular transformation (SANT) is a rare benign splenic vascular lesion. Since it was first defined in 2004, a total of 132 cases of SANT have been reported in ~50 studies in the English literature. However, it remains difficult to form a definitive pre-operative differential diagnosis of SANT compared with other splenic tumors or malignant lesions. The present study reports a pathologically proven case of SANT in a 29-year-old man who initially presented with left upper quadrant and back discomfort. The study also provides a review of the current knowledge on the condition, including the clinical profile, imaging features, cytological features, differential diagnosis and treatment of SANT. The most important distinguishing features of SANT are its typical vascular character and lack of other features that are typical of a granuloma. A splenectomy is required and the diagnosis is based on pathological analysis.