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

Gooch, Cory; Gaballah, Ayman H.; Nelson, J R; Wade, Marcus; Chen, Rong

doi:10.1016/j.radcr.2018.08.035

Cited by 7 publications

(8 citation statements)

References 15 publications

(17 reference statements)

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“…This pattern is due to central stellate fibrous stroma with fibrous septa separating angiomatoid nodules. 9,10 MRI of SANT on T2-weighted imaging show the lesion as a spoke-and-wheel pattern, which is similar to the pattern obtained by multiphase imaging with CT and may be useful for the diagnosis of SANT. 6 Pre-operative diagnosis of SANT is difficult with no specific or sensitive method available to rule out malignancy and other differential diagnosis.…”

Section: Discussionsupporting

confidence: 65%

Sclerosing angiomatoid nodular transformation of spleen: an uncommon benign lesion of spleen

Sekaran¹,

Reddy²,

Shetty

et al. 2021

Int J Res Med Sci

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SANT (sclerosing angiomatoid nodular transformation) is a rare benign vascular tumour of spleen. SANT can mimic benign and malignant conditions of spleen. There are no definite radiological features. It has characteristic histopathology and immunohistochemistry findings which help us to differentiate it from other angiomatoid and tumor-like lesions. Splenectomy is the treatment of choice as it is diagnostic and therapeutic at the same time. We present a case of 22 years female with left upper quadrant pain since, 2 months. Magnetic Resonance Imaging revealed well-defined hypodense mass measuring 6.3×6.1×5.8cm in the spleen, with provisional diagnosis of hemangioma. Laproscopic splenectomy was done and a diagnosis of SANT was made on histology and immunohistochemistry. This case shows us that SANT should be considered in the differential diagnosis of splenic solid lesions.

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Section: Discussionsupporting

confidence: 65%

Sclerosing angiomatoid nodular transformation of spleen: an uncommon benign lesion of spleen

Sekaran¹,

Reddy²,

Shetty

et al. 2021

Int J Res Med Sci

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“…Other signs and symptoms that have been described in literature include pelvic or flank pain, vomiting, constitutional symptoms (such as fever, weight loss and night sweats), hematologic abnormalities (e.g. thrombocytopenia, pancytopenia and anemia) and splenomegaly [ 2 , 3 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Rapidly growing sclerosing angiomatoid nodular transformation of the spleen

Sohail¹,

Eze

Sohail

et al. 2021

Journal of Surgical Case Reports

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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.

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“…Moreover, SANT may be indirectly associated with other cases of malignity that have comorbidities (16%, n = 37) (colorectal cancer 2.1%, gastric cancer 2.1% and lung cancer 1.3%) as SANT was detected incidentally during the follow-up of primary malignities [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] ]. The literature reports three cases of thrombocytopenia in patients with SANT [ 6 , 73 , 77 ]. Dieobold et al [ 6 ] reported a patient presenting with thrombocytopenia due to paramyxovirus 19.…”

Section: Discussionmentioning

confidence: 99%

“…Dieobold et al [ 6 ] reported a patient presenting with thrombocytopenia due to paramyxovirus 19. Gooch et al [ 73 ] noted that the surgical oncology consultation agreed that a splenic mass was the most likely cause of thrombocytopenia in their patient. Finally, Pelizzo et al [ 77 ] reported a case of SANT occurring in a nine-week-old female infant who was admitted with severe abdominal distension and rectal bleeding, severe anemia (Hb 4.6 g/dL), thrombocytopenia (54 × 103/μL) and coagulation abnormalities resulting from persistent abdominal hemorrhaging from ruptures of the spleen capsule that were un-responsive to blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

“…The curative treatment for SANT is splenectomy [ 46 , [48] , [49] , [50] , [51] , [52] , [53] , [55] , [56] , [57] , [58] , [59] , [60] ]. Open splenectomy or minimally invasive splenectomy are both options for surgical treatment [ [62] , [63] , [64] , [65] , [66] , [67] , [68] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] ]. In recent years, minimally invasive surgery such as robotic or laparoscopic splenectomy has become more popular due to a shorter hospital stay, less postoperative abdominal pain, and an early return to normal activity [ 18 , [63] , [64] , [65] , 78 ].…”

Section: Discussionmentioning

confidence: 99%

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

Cited by 7 publications

References 15 publications

Sclerosing angiomatoid nodular transformation of spleen: an uncommon benign lesion of spleen

Sclerosing angiomatoid nodular transformation of spleen: an uncommon benign lesion of spleen

Rapidly growing sclerosing angiomatoid nodular transformation of the spleen

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

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