Sclerosing Angiomatoid Nodular Transformation of the Spleen: An uncommon Cause of Abdominal Pain

Rapidly growing sclerosing angiomatoid nodular transformation of the spleen

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular lesion with unknown pathogenesis and no definitive pathognomonic radiological features. The majority of patients with SANT are asymptomatic, and the lesion is an incidental finding on cross-sectional imaging performed for unrelated reasons or during intra-abdominal surgery. However, in the symptomatic minority, abdominal pain is the most commonly reported symptom. SANT generally remains stable or has very slow growth, making it amenable to surveillance using serial cross-sectional imaging. Herein, we report the unusual case of SANT in a 30-year-old female with rapid growth from 6.0 × 5.6 × 4.4 cm to 8.0 × 6.6 × 7.2 cm over 21 months. Given the rapid growth, it was imperative to rule out malignancy. Thus, the patient underwent a laparoscopic total splenectomy. For SANT, splenectomy serves the dual purpose of diagnosis and definitive therapy.

Sclerosing angiomatoid nodular transformation (SANT) of the spleen: a rare cause of acute abdomen

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is an extremely rare benign lesion. It originates from the spleen's red pulp; however, its pathogenesis is not clearly defined. These tumors are usually asymptomatic or cause nonspecific abdominal symptoms. Most SANTs are found incidentally on radiographic examination or during surgery for an unrelated condition. The differential diagnosis from other splenic tumors or malignant lesions can be challenging due to the risk for a possible malignancy of the suspicious lesion. As more SANTs are being discovered and treated, they should always be considered in the differential.

We present the case of an otherwise healthy 30-year-old female; she presented with abdominal pain and a mass in her spleen. Surgery was performed, and an SANT was discovered. The patient underwent full recovery, and on follow-up is doing well.

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 of the spleen

The authors described a case of sclerosing angiomatoid nodular transformation of the spleen (SANT) in a 50-year-old woman presented with persistent neutrophilia and unintentional weight loss. An incidental splenic mass was initially found on abdominal ultrasound. It was found to be progressive in size and with high likelihood of central necrosis on further CT of abdomen and pelvis. The patient subsequently underwent an uneventful laparoscopic splenectomy. The splenic specimens were sent for laboratory analysis and the histopathological findings were highly suggestive of SANT. The patient then had routine surgical follow-ups and was eventually discharged with no further clinical concern.

Sclerosing angiomatoid nodular transformation presenting with abdominal hemorrhage: First report in infancy

A limited number of sclerosing Angiomatoid Nodular Transformation (SANT) have been reported in pediatric age. We describe the first case of SANT occurring in a nine-week-old female infant that was admitted to our unit for severe abdominal distension and rectal bleeding. Enlarged spleen was detected on physical examination. Laboratory investigations revealed severe anemia and coagulation abnormalities. Abdominal ultrasound and computed tomography revealed ascites and splenomegaly with a large mass at the lower medial splenic pole. A diagnosis of intraabdominal hemorrhage was presumed and an exploratory laparotomy was performed. A complete transformation of the giant splenomegaly to bossellated masses and multiple bleeding capsular ruptures without subcapsular hematoma were found and an urgent splenectomy was performed. At histology, a SANT was diagnosed (CD34, CD31, CD8 positivity). The postoperative follow up was uneventful. SANT may also occur in infancy with a potentially lifethreatening presentation. Splenectomy may represent the only treatment in severe cases.

Sclerosing angiomatoid nodular transformation (SANT) of the spleen: A case report on CT and MRI

Solid tumors of the spleen are rare, with an incidence of 0.007% in all operating and autopsy specimens. In terms of microscopic structure and function, the spleen consists of two parts: the white pulp, which plays an important role in the immune system and the red pulp, which filters the blood.Primary splenic neoplasms can be classified into lymphoid neoplasms arising from the white pulp, and vascular neoplasms which arise from the red pulp.Primary tumors arising from vascular elements include benign lesions such as hemangioma, lymphangioma and hamartoma, intermediate lesions such as hemangioendothelioma, hemangiopericytoma and littoral cell angioma as well as the frankly malignant hemangiosarcoma.It is usually difficult to distinguish a benign from a malignant lesion with preoperative imaging studies and cytological exam by fine-needle aspiration (FNA), that is not easily obtained because of the risk of bleeding.Therefore a splenectomy should be necessary for a definitive diagnosis of splenic tumors.Martel and all for the first time described the sclerosing angiomatoid nodular transformation (SANT), like a vascular lesion of the spleen, with benign clinical course consisting by altered red pulp tissue that has been entrapped by a non-neoplastic stromal proliferative process.We describe a rare case of benign splenic mass documented with FDG/PET-CT (referred as equivocal), CT and MRI.

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

RATIONALE

Sclerosing angiomatoid nodular transformation (SANT) is a rare case which usually occurs in spleen, but our case occurs in accessory spleen.

PATIENT CONCERNS

We reported a case of a 27 year old man who was identified with an isodense mass in the left abdominal cavity by ultrasonicphysical examination without symptoms. Blood routine and tumor markers (alpha fetal protein, carcinoembryonic antigen, CA19-9, CA125) were normal.

DIAGNOSES

The tumor was firstly diagnosed as left abdominal mass and its origin was considered as small intestinal by the radiologist. The pathological diagnosis was the sclerosing angiomatoid nodular transformation (SANT) of the accessory spleen.

INTERVENTIONS

Laparoscopic splenectomy is a more reliable method for the treatment of SANT.

OUTCOMES

Non-enhanced CT showed iso-intensity lesion of the accessory spleen, and enhanced CT showed progressive enhancement. According to the above characteristics, we should consider the diagnosis of spleen SANT. We reviewed some literatures to summarize the characteristics of SANT.