Sclerosing angiomatoid nodular transformation (SANT) of the spleen: a case report with FDG-PET findings and literature review

Imamura, Yumi; Nakajima, Reiko; Hatta, Kazuha; Seshimo, Akiyoshi; Sawada, Tatsuo; Abe, Koichiro; Sakai, Shuji

doi:10.1177/2058460116649799

Cited by 16 publications

(15 citation statements)

References 13 publications

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“…Reports concerning the findings of SANT on PET-CT are sporadic. Imamura et al reviewed the features of SANT in 2016 (13) and reported that 10 of 11 cases showed the uptake of FDG in SANT, suggesting that PET-CT can be considered to provide an accurate diagnosis. However, this finding is not consistent with the present case (Fig.…”

Section: Discussionmentioning

confidence: 99%

Sclerosing Angiomatoid Nodular Transformation of the Spleen: Lessons from a Rare Case and Review of the Literature

et al. 2019

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Sclerosing angiomatoid nodular transformation (SANT) of the spleen is an extremely rare benign lesion. We herein report a case of asymptomatic SANT of the spleen in a middle-aged woman with early breast carcinoma and an undiagnosed splenic mass, which was successfully treated by laparoscopic splenectomy and diagnosed postoperatively. We also review the literature on SANT to help make knowledge more accessible when clinicians encounter a splenic tumor. The present case taught us the following lesson: the presence of a splenic lesion during follow-up for malignancy is not always indicative of metastasis. Therefore, SANT should be considered in the differential diagnosis.

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Section: Discussionmentioning

confidence: 99%

Sclerosing Angiomatoid Nodular Transformation of the Spleen: Lessons from a Rare Case and Review of the Literature

et al. 2019

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“…The clinical and the radiological characteristics of this entity are not specific, except for a radiological appearance of a nonadenomatous lesion at abdominal CT-scan. The role of the 18 F-FDG PET scan is uncertain, even though a mild uptake may be detected, as previously reported in spleen lesions [5]. Therefore, adrenal malignancy and pheochromocytoma should be considered in the differential diagnosis of this condition, which can be diagnosed only after histopathological examination.…”

Section: Discussionmentioning

confidence: 95%

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

Zavatta

Leo

Bacci

et al. 2019

Journal of the Endocrine Society

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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.

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“…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] ].…”

Section: Discussionmentioning

confidence: 99%

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 (SANT) of the spleen: a case report with FDG-PET findings and literature review

Cited by 16 publications

References 13 publications

Sclerosing Angiomatoid Nodular Transformation of the Spleen: Lessons from a Rare Case and Review of the Literature

Sclerosing Angiomatoid Nodular Transformation of the Spleen: Lessons from a Rare Case and Review of the Literature

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

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

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