An unusual case of sclerosing angiomatoid nodular transformation: radiological and histopathological analyses

Metin, Melike Ruşen; Evrimler, Şehnaz; Çay, Nurdan; Çeti̇n, Hüseyin

doi:10.3906/sag-1304-141

Cited by 7 publications

(7 citation statements)

References 17 publications

(19 reference statements)

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“…In the remaining patients, the main symptom was abdominal pain ( n = 39). Other symptoms were a palpable abdominal mass, cytopenias, flank pain, pelvic pain, fever, nosebleed and anemia [ 6 , 7 ], vomiting, pruritus in the lower limbs [ 8 ], and weight loss [ 9 ]. There were two reported deaths in the Martel's cases [ 1 ]: a 56-year-old woman who died of disseminated lung adenocarcinoma and a 46-year-old man with concurrent bronchogenic squamous cell carcinoma who died of sepsis post splenectomy.…”

Section: Discussionmentioning

confidence: 99%

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

Cipolla

Florena

Ferrara

et al. 2018

Case Reports in Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

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

Cipolla

Florena

Ferrara

et al. 2018

Case Reports in Surgery

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“…The weight of splenectomy specimens in the literature varies from 68 to 2720 g, most cases being recorded after total splenectomy. During operation or macroscopic examination, certain signs may be visible; particularly, the mass appears as multiple individual and confluent nodules with sizes ranging from 1.2 to 17 cm (median size:5.2 cm), well-circumscribed, non-encapsulated, a bosselated mass with multiple dark brown nodules (bleed areas in angiomatoid nodules) interspersed with fibrotic stroma [ 24 , [37] , [38] , [39] , [40] ]. In the literature, most authors (>95%) reported multiple nodules and fibrotic stroma or scars [ 2 , 20 , [40] , [41] , [42] , [43] , [44] , [45] ].…”

Section: Discussionmentioning

confidence: 99%

“…A total of 230 SANT patients undergoing laparoscopic, open splenectomy or biopsy between 2004 and April 2020 were reported on in English language literature [ [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] ]. Patient information was only retrieved from English language medical databases with full-texts, using Google Scholar, PubMed, Scopus and Research-gate.…”

Section: Systematic Literature Reviewmentioning

confidence: 99%

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

Aziret

Yılmaz

Kalpakci

et al. 2020

Annals of Medicine and Surgery

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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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“…Macroscopically, on the cross-section of the spleen, the change has a starry aspect. In a large number of reports, the starry shape of SANT has the "spoked wheel" appearance in MDCT and T2weighted MRI images [18,19,20]. However, characteristic and pathognomic radiological findings, which could help unequivocally diagnose SANT, have not been defined yet.…”

Section: Discussionmentioning

confidence: 99%

Sclerosing angiomatoid nodular transformation of the spleen - An uncommon splenic pseudotumorus variant

Grubor¹,

Tadić²,

Micev

et al. 2019

Srp Arh Celok Lek

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Introduction Sclerosing angiomatoid nodular transformation is a benign splenic pseudotumorous multinodular vascular proliferation. In the past, it was usually reported as splenic hamartoma, multinodular hemangioma or splenic hemangioendothelioma. Since it was defined in 2004, a total of 150 cases have been reported. We will present our experience with a 58-year-old female patient who underwent splenectomy due to the tumorous change in the upper pole of the spleen, histopathologically characterized as sclerosing angiomatoid nodular transformation of the spleen. Case outline A 58-year-old women presented with abdominal pain, anemia, elevated C-reactive protein and fibrinogen level. Abdominal ultrasound and MDCT scan found a well-circumscribed, homogeneous, low-density tumor in the upper pole of the spleen. As the nature of the tumorous change could not be accurately determined and malignancy could not be excluded, splenectomy was performed. Histological findings showed multiple similar nodular foci, hardly discernible from splenic parenchyma, angiomatoid nodules surrounded and separated by partly collagenized fibroblastic areas admixed with mononuclear inflammatory infiltrate in various proportions. All findings were characterized as the coexistence of sclerosing angiomatoid nodular transformation of the spleen and splenic inflammatory pseudotumor. Conclusion Splenectomy, laparoscopic or open, is an acceptable therapeutic and at the same time diagnostic method. Considering the important role of the spleen in the immune system, partial splenectomy is also an option, especially in children. However, the coexistence of sclerosing angiomatoid nodular transformation of the spleen and inflammatory pseudotumor indicates a careful treatment decision, given the tendency of inflammatory pseudotumor to relapse, and, rarely, the possibility of malignant transformation.

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An unusual case of sclerosing angiomatoid nodular transformation: radiological and histopathological analyses

Cited by 7 publications

References 17 publications

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

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

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

Sclerosing angiomatoid nodular transformation of the spleen - An uncommon splenic pseudotumorus variant

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