Sclerosing angiomatoid nodular transformation of the spleen presenting as a rapidly growing tumour in a patient with rectal cancer

Sclerosing angiomatoid nodular transformation mimicking a splenic metastasis from rectal cancer: A case report

Sclerosing angiomatoid nodular transformation (SANT) is a rare, benign lesion of the spleen. Preoperative diagnosis of SANT without pathological examination poses significant challenges, particularly in patients with a previous history of malignancy. The present study describes the case of a 53-year-old woman that presented to our institution with general fatigue and anemia. Based on a diagnosis of rectal cancer, the patient underwent curative surgery. Postoperatively, with minor leakage and the need for endoluminal drainage, the patient was monitored without adjuvant chemotherapy. A total of 1 year post-operation, enhanced computed tomography (CT) revealed a low-density lesion measuring 7 mm in the spleen. While metachronous metastasis was considered, there was no accumulation of 18F-fluorodeoxyglucose, and the levels of tumor markers, such as carcinoembryonic antigen and carbohydrate antigen 19-9, remained unremarkable. Regular surveillance through contrast-enhanced CT was performed. Over a period of 3 years, the tumor gradually increased to 25 mm. After a diagnosis of metachronous metastasis from rectal cancer, the patient opted for surgery, and laparoscopic splenectomy was performed successfully. Histopathological examination of multiple angiomatoid nodules in the fibrosclerotic stroma confirmed the diagnosis of SANT. The postoperative course of the patient was uneventful. In cases of SANT following a prior malignancy, splenectomy should be considered for both diagnostic and therapeutic purposes.

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.

A sclerosing angiomatoid nodular transformation (SANT) mimicking a metachronous splenic metastasis from endometrioid cancer and ovarian cancer

INTRODUCTION

Sclerosing angiomatoid nodular transformation (SANT) of the spleen has been considered a differential diagnosis of splenic lesions since it was originally reported. However, preoperative diagnosis of SANT is often difficult and histopathological examination by surgical resection is required.

CASE PRESENTATION

Because of a new splenic lesion, a 48-year-old woman was suspected of having metachronous solitary splenic metastasis during her postoperative follow-up for endometrioid and ovarian cancer that occurred 3 years previously. Because there was no metastasis to other sites, laparoscopic splenectomy was successfully performed for diagnosis and treatment. Histopathological examination revealed that the splenic lesion consisted of three distinct splenic vessels, thereby indicating SANT without any cancer cells or lymphoproliferative disorders.

CONCLUSION

Splenectomy should be considered for the diagnosis and treatment of incidentally detected splenic lesions during follow-up for malignancy.

Sclerosing Angiomatoid Nodular Transformation (SANT) of the spleen: Case report and review of the literature

INTRODUCTION

Sclerosing Angiomatoid Nodular Transformation of the spleen (SANT) is a rare benign vascular lesion of the spleen with extensive sclerosis and unknown etiology.

PRESENTATION OF CASE

We report a new case of SANT of the spleen found in a 53-year-old female following detection of a splenic mass on a routine computed tomography (CT). The patient underwent an uncomplicated laparoscopic splenectomy and the specimen was sent for histopathologic examination.

DISCUSSION

A review of the 97 reported cases of SANT found in the literature was undertaken. There were 43 males and 54 females with a median age of 46 years (range: 11-82 years). SANT is classically considered to be a female predominant disease, however 44.3% of reported case were male and the gender predilection may soon be neutralized as more cases are reported. 65 of the 97 (67%) patients were in 30-60 year age group. The majority of lesions (n=50) were incidentally found on imaging, and for those patients presenting with symptoms, abdominal pain (n=18) was the predominant symptom.

CONCLUSION

The diagnosis of SANT should be considered in any patient presenting with a splenic lesion that contains an angiomatoid or inflammatory component. As the differential diagnosis for SANT includes malignant pathologies, and currently no reliable diagnostic radiological feature has been identified to differentiate between these conditions, SANT will continue to be diagnosed on the basis of surgical histopathology.