Multimodality imaging of splenic sclerosing angiomatoid nodular transformation

Abstract

Sclerosing angiomatoid nodular transformation (SANT) is an exceedingly rare, benign and proliferative vascular lesion that arises from the splenic red pulp. It is often an incidental finding on imaging. The diagnosis of SANT is confirmed via histopathological examination of the resected spleen. Herein, we present a case of SANT and describe its typical imaging characteristics. An asymptomatic 39-year-old man was found to have a 3.1 cm × 2.7 cm × 2.3 cm hypoechoic splenic lesion during abdominal ultrasonography, which was performed to investigate his elevated gamma-glutamyl transpeptidase and alanine transaminase levels. Contrast-enhanced computed tomography suggested a vascular splenic lesion, while magnetic resonance imaging demonstrated features consistent with SANT. In view of the increasing size of the lesion on follow-up imaging, the patient elected for splenectomy. Histopathological examination confirmed SANT, and the lesion was completely resected by laparoscopic splenectomy.

Sclerosing angiomatoid nodular transformation (SANT) of spleen mimicking a splenic abscess: Case report and review of the literature

“…Clinically, SANT is only a kind of described pathological diagnostic conception. As in our case, these splenic lesions are often incidental findings on imaging studies performed for other reasons [16]. SANT is classically considered to be a female-predominant disease, with most of the patients in the 30- to 60-year age group.…”

Sclerosing angiomatoid nodular transformation of the spleen: A case report of thrombocytopenia and a hypervascular splenic mass

“…The first report of CT findings in SANT described a hypodense mass in early portal venous phase imaging which became homogenous postcontrast and indistinguishable from normal spleen on late portal venous phase images [8] . Others have reported findings of peripheral nodular enhancement on arterial phase imaging, hypervascular rim during portal venous phase imaging, and progressive enhancement toward isodensity on delayed imaging [9] , [10] , [11] , [12] , [13] . The radial scarring associated with the gross pathology may be visible on CT, but it is most prominent on MRI [14] .…”

Sclerosing Angiomatoid Nodular Transformation of the Spleen: A Diagnostic Conundrum

“…The enhancement pattern on multiphase MRI is similar to CT, consisting of nodular enhancement of the periphery in the early arterial phase with a progressive centripetal filling through radiating septa in the delayed phase ( Fig. 2C–D ) [ 8 9 10 15 16 17 18 19 20 21 ]. A central scar may be seen on T1- and T2-WI and was present in 26% of cases [ 8 10 17 22 23 ].…”