Sclerosing Angiomatoid Nodular Transformation of the Adrenal Gland: A Case Report of a Novel Histopathological Entity

Abstract

The finding of an indeterminate adrenal mass at radiological investigations is a challenge for physicians. Complex diagnostic work-up, periodic follow-up, or surgical intervention are therefore needed to rule out malignant lesions. Tertiary care hospitals are provided with 18 F-fludeoxyglucose ( 18 F-FDG) positron emission tomography (PET) and 18 F-dihydroxyphenylalanine ( 18 F-DOPA) PET, which aid in the characterization of indeterminate adrenal masses. Nevertheless, the histopathological examination may be required to exclude malignancy or rare etiologies. A 54-year-old woman presented to our clinic 6 months after a cerebral hemorrhage. She was hypertensive and had recently discovered a left adrenal mass of 15 mm during an abdominal ultrasound. Contrast-enhanced CT, following adrenal protocol, revealed a 14-mm adrenal mass without characteristics suggestive of an adrenal adenoma. Tumor markers were negative. Functional tests excluded hormone hypersecretion. An 18 F-DOPA PET was negative. An 18 F-FDG PET showed mild uptake of both the adrenal glands, with a more circumscribed pattern in the left one (maximum standardized uptake value = 4). As the clinical diagnosis was still indeterminate, we performed laparoscopic left adrenalectomy. The histopathological examination described a sclerosing angiomatoid nodular transformation (SANT) of the adrenal gland, a benign lesion already described as a rare occurrence only in the spleen. IgG4 levels were reduced. In conclusion, this is a report of a SANT of the adrenal gland, a novel entity that should be taken into consideration in the differential diagnosis of indeterminate adrenal masses at CT scan.

Sclerosing Angiomatoid Nodular Transformation of the Spleen: A Diagnostic Conundrum

“…The mean age in the study population was 44 years, correlating well with other, not included reviews [ 2 3 ]. SANT is almost exclusively described in the spleen, except for one reported at the adrenal gland [ 4 ]. At diagnosis these lesions may be large with a mean diameter of 49 to 175 mm [ 3 ].…”

Sclerosing Angiomatoid Nodular Transformation of the Spleen: A Report of Rare Case and Literature Review

“…Open or laparoscopic splenectomy is currently the preferred treatment for SANT to avoid the risk of spontaneous vessel rupture and to rule out the suspicion of malignancy [ 5 ]. Although SANT is typically confined to the spleen, there has been a reported case involving the adrenal gland [ 6 ].…”

Sclerosing Angiomatoid Nodular Transformation of the Spleen: A Case Report

“…Many patients diagnosed with SANT have had a pre-existing or simultaneous malignant neoplasm, including breast cancer, ductal carcinoma of the pancreas, uterine clear cell carcinoma, colon cancer with liver metastasis, rectal cancer, hypopharynx, and thyroid carcinoma etc rare, it is not well-known to clinicians, surgeons, radiologists, or pathologists. 5 Thus, SANT is often misdiagnosed as in ammatory pseudotumor, hamartoma, and hemangioendothelioma 1,10 . Here we present the histopathological and immunohistochemical evidence used to diagnose SANT in a 32 year-old-man with a history of two old injuries and who subsequently presented with left upper quadrant pain.…”