Sclerosing Angiomatoid Nodular Transformation of the Spleen: Analysis of Clinical and Pathological Features in Five Cases

Abstract

Objective: We aimed to summarize the clinical and pathological features of sclerosing angiomatoid nodular transformation (SANT) in spleen among five cases.Methods: Five cases (male: 3; female: 2; mean age: 47.6 years) with SANT confirmed by pathological analysis between July 2010 and November 2019 in our hospital were included in this study. The clinical, imaging, and pathological data were analyzed retrospectively.Results: Three patients presented with mild abdominal pain or discomfort, while the other two were symptom free. Two patients received ultrasonography (US), and all patients underwent a computerized tomography (CT) scan in our hospital. The typical “spoke wheel” pattern was seen in two cases, and central calcification was detected in one case on the CT scans. All patients indicated peripheral enhancement around the SANT lesion during the arterial phase. Open or laparoscopic splenectomy was performed for treatment. No patient showed recurrence in the follow-up. The pathological characteristics of our cases were in line with those of previous literatures.Conclusions: Peripheral enhancement around the SANT lesion during the arterial phase should be taken into consideration for the diagnosis of SANT as an imaging sign on CT scans. Special attention should be paid to the splenic integrality during the laparoscopic approach, due to the probability of malignancy and the fragility of the spleen.

Sclerosing angiomatoid nodular transformation (SANT) of the spleen: review of the literature

“…Regarding the CT scan, SANT usually presents as a hypodense or isodense complex mass which is located in any site of the spleen, as in our case. According to the literature, the "spoke wheel pattern" is usually considered as a typical manifestation in CT images, but it is not available in all patients (3,4). Moreover, none of the radiological features are pathognomonic of SANT, and further studies are required to differentiate SANT from malignant lesions of the spleen (1).…”

Sclerosing Angiomatoid Nodular Transformation (SANT): A Rare Splenic Tumor and Unusual Cause of Anemia

“…It was found that multiple SANT has inconsistent imaging findings, and this may be due to a smaller number of cases reported or differing pathogenesis between single and multiple SANTs [ 16 ]. More recently, a study of 5 patients with SANT by Shao et al proposed the finding of peripheral enhancement of a splenic lesion in arterial phase CT to be considered a sign suggestive of SANT [ 17 ].…”

“…Macroscopically, SANT presents as a well-demarcated mass with a central gray-white stellate scar and peripheral reddish-brown nodules. On a microscopic view, multiple angiomatous nodules surrounded by fibrous collagen tissue can be seen, in addition to lining of micronodular vascular spaces by plump endothelial cells interspersed with ovoid spindle cells [ 17 , 23 ].…”