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

Cipolla, Calogero; Florena, Ada Maria; Ferrara, Gabriella; Gregorio, Riccardo Di; Unti, Elettra; Giannone, Antonino Giulio; Lazzaro, Luigi A.; Graceffa, Giuseppa; Pantuso, Gianni

doi:10.1155/2018/7020538

Cited by 12 publications

(24 citation statements)

References 24 publications

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“…Case reports published so far do not offer the possibility to distinguish a prominent clinical characteristic that can be associated with SANT. The most common symptoms that the patients experienced are a sense of abdominal discomfort and occasional dull abdominal pain [13]. Pain in the joints and laboratory analyses of our patient with high levels of C-reactive protein, fibrinogen, and leukocytes may indicate the existence of some type of general inflammatory response.…”

Section: Discussionmentioning

confidence: 67%

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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Section: Discussionmentioning

confidence: 67%

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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“…Martel et al [1], in a series of 25 cases, have reported that SANT was significantly more common in women than in men, with an average age of 48.4 years. Recently, Cipolla et al [2], in a series of 152 cases, have reported that the ratio of occurrence of SANT in men and women was similar (1:1.08) and that the average age was 45.4 years. Although patients with SANT sometimes present with abdominal pain, most cases have no specific clinical symptoms and are often incidentally found during routine imaging.…”

Section: Discussionmentioning

confidence: 94%

“…They reported that SANT was significantly more common in women than in men, with an average age of 48.4 years. Recently, it has been reported that the ratio of occurrence of SANT in men and women was similar [2].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Splenectomy in a Patient with Sclerosing Angiomatoid Nodular Transformation

Kusano¹,

Ryu²,

Matsuo³

et al. 2020

Case Rep Gastroenterol

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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 longterm natural history of SANT is unknown, we believe that splenectomy could be an appropriate technique for the diagnosis and treatment of SANT.

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“…SANT of the spleen is a benign, nonhematolymphoid tumor that arises in the red pulp of the spleen (Tracher, Abbot). 8,9 Since its first description in 2004 by Martel et al ., 2 155 cases of SANT have been reported in adults (Cipolla, cao), 10,11 while only four cases have been reported in pediatric patients (Table 1). Zhang et al 6 described a 3-year-old child injured in a car accident with a postsplenectomy SANT diagnosis; Vyas et al 4 presented a case of SANT with inflammatory pseudotumor-like areas in an 11-year-old child with a history of trauma presenting with a rapidly growing splenic lesion; Agrawal et al 3 described SANT in a 12-year-old girl with upper quadrant discomfort which lasted six months; Kuybuli et al .…”

Section: Discussionmentioning

confidence: 99%

Sclerosing Angiomatoid Nodular Transformation Presend Nodulartransformation Presenting with Abdominal Hemorrhage: First Report in Infancy

Pelizzo¹,

Villanacci

Lorenzi

et al. 2019

Pediatric Reports

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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.

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

Cited by 12 publications

References 24 publications

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

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

Laparoscopic Splenectomy in a Patient with Sclerosing Angiomatoid Nodular Transformation

Sclerosing Angiomatoid Nodular Transformation Presend Nodulartransformation Presenting with Abdominal Hemorrhage: First Report in Infancy

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