Sclerosing angiomatoid nodular transformation of the spleen: case report of a metastatic carcinoma-simulating disorder

Abstract

Sclerosing angiomatoid nodular transformation (SANT) is a rare nonneoplastic splenic disorder of unknown etiopathogenesis. This condition is usually found incidentally on imaging studies. Because of its similar features, SANT can wrongly be described as metastatic carcinoma. A 61-year-old Caucasian male was referred to our general surgery outpatient clinic regarding unusual splenic nodular formations in a routine abdominal ultrasound. All diagnostic exams performed confirmed metastatic splenic lesions, but no primary tumor was found. A laparoscopic splenectomy was performed for diagnostic purposes. Histopathology revealed SANT. Benign tumors of the spleen are uncommon entities and can easily be mistaken by malignant secondary lesions. The differential diagnosis of SANT should include other vascular lesions as well as metastatic carcinoma and inflammatory pseudotumor. It is widely recommended that a splenectomy should be performed because only by histopathology and immunohistochemistry staining, the definitive diagnosis of SANT can be made.

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

“…Most patients with SANT are asymptomatic, with incidental findings of splenomegaly on physical examination or imaging performed for other unrelated conditions [ 4 , 8 ], as occurred in our patient, but some patients present with non-specific symptoms of abdominal pain, nausea, vomiting, anemia or malnutrition [ 5 , 9 , 10 ]. Our patient had chronic anemia not responding to dietary changes and iron supplementation.…”

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

“…Previously, there was no consensus on the nomenclature for this clinicopathological pattern. It was usually misdiagnosed as hemangioma, hemangiosarcoma, inflammatory pseudotumor, hamartoma ( 1 ), and even metastatic tumors ( 7 ). In 2004, Martel et al summarized the pathological features and defined it as SANT for the first time ( 2 ).…”

“…The clinical manifestation of SANT is asymptomatic or non-specific, with most lesions identified incidentally ( 5 ) or during the treatment of other unrelated diseases ( 6 ). Others exhibited featureless symptoms such as abdominal pain ( 7 ), nausea, vomiting, and malnutrition ( 8 ). Recently, Pelizzo et al reported a case of SANT with spontaneous mass rupture and intraperitoneal hemorrhage in a 9 week-old female infant ( 9 ).…”

“…The vast majority of SANT patients are usually symptom free, with lesions detected occasionally by physical examinations ( 5 ) or during the treatment of other unrelated diseases ( 6 ). Some cases may present non-specific symptoms, such as abdominal pain ( 7 ), nausea, vomiting, and malnutrition ( 8 ). To date, the diagnosis of SANT is still a challenge without histological examinations, despite the fact that computerized tomography (CT) and magnetic resonance imaging (MRI) provide imaging support before surgery ( 5 , 6 ).…”

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

“…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 ].…”