Sclerosing Angiomatoid Nodular Transformation of the Spleen: A Diagnostic Conundrum

Abstract

A splenic lesion often represents a diagnostic challenge due to relative scarcity and the broad differential diagnosis. Sclerosing Angiomatoid Nodular Transformation (SANT) of the spleen is usually encountered only incidentally. Although benign, patients with SANT often receive splenectomy, due to its rarity, diagnostic uncertainty and sometimes intimidating imaging morphology and size. Imaging features on computed tomography, magnetic resonance and positron emission tomography have a high diagnostic value for SANT and help differentiate this entity from other splenic lesions. When the imaging parameters are matched with core needle biopsy tissue analysis, further watchful waiting can be recommended in order to avoid splenectomy.

Sclerosing angiomatoid nodular transformation of the spleen: multimodality imaging features and literature review

“…The"spoke-wheel"pattern, considering as an typical imaging feature, had low sensitivity, which was presented in 5 cases (41.7%) in our study and 11 cases(48%) in a recent review study. [16] Progressive eccentric and circumferential enhancement were observed in 2 cases (16.7%) in our study. Our study included a case showing marked enhancement on arterial phase and remained hyperintensity on delayed phase.…”

“…[9] Due to the recent review literature, about 51.6% of SANT presented hypointensity on T2WI, showing a better sensitivity than "spoken-wheel" patten(48%). [16] A more significant signal decrease could be seen on DWI and T2WI because of a more significant susceptibility effect of DWI. Therefore, DWI may be more effective than enhanced CT, T2WI and dynamic MRI in diagnosing SANT, with features of hypointensity on DWI and hyperintensity on ADC map in few literature [8][9][10].…”

The Spectrum of Solitary Benign Splenic Lesions—Imaging Clues for a Noninvasive Diagnosis

“…Sclerosing Angiomatoid Nodular Transformation (SANT) is a rare benign vascular disorder of unknown cause, with the same prevalence as inflammatory pseudotumors and approximately 170 cases described in the scientific literature. SANT is almost exclusively described in the spleen, except for one reported in the adrenal gland [ 41 ]. Half of SANTs are asymptomatic, and half are diagnosed because of abdominal pain, pancytopenia, and splenomegaly.…”

“…SANT appears as a well-circumscribed, solitary round mass, typically 3–17 cm in size. It is often mistaken for a sclerosed hemangioma or an inflammatory pseudotumor and can mimic a malignancy [ 41 ]. On CT, they present as iso- to hypoattenuating masses, while they appear isointense on T1-WI but can show areas of hyperintensity or susceptibility if a hemorrhage is present.…”