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Alemu S, Mulatu B, Kedir A, Minka M, Tesfaye W, Reta Demissie W. A rare case of sclerosing angiomatoid nodular transformation of spleen: A case report. Int J Surg Case Rep 2025; 126:110745. [PMID: 39700586 PMCID: PMC11722181 DOI: 10.1016/j.ijscr.2024.110745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 12/11/2024] [Indexed: 12/21/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Sclerosing angiomatoid nodular transformation of the spleen is a rare benign vascular lesion arising from red pulp of spleen with unknown etiopathogenesis. It is a non-neoplastic condition that affects the spleen only; not described in other sites except one case reported in adrenal gland. Epidemiologically it has slight female predilection. It is a very rare ailment where the present finding is very crucial in the management of similar cases so far. CASE PRESENTATION A 31 years old female patient presented with left flank pain and constipation of 01 year duration. An abdominopelvic CT scan showed a hypodense mass in the left upper quadrant of abdomen just anterior to inferior pole of spleen with the conclusion of mesenteric mass likely gastrointestinal stromal tumor. Finally, it was decided and exploratory laparotomy was done and the surgeon identified the mass in the inferior pole of spleen and total splenectomy was done, and the specimen is sent for pathologic evaluation. The final histopathologic diagnosis became sclerosing angiomatoid nodular transformation of spleen with the classic microscopic findings of multiple confluent angiomatoid nodules surrounded by variable concentric fibrosclerotic stroma. CLINICAL DISCUSSION Sclerosing angiomatoid nodular transformation of spleen is a benign incidentally identified vascular condition of red pulp in the majority of cases. Preoperative diagnosis is not easy since it is difficult to obtain the tissue from the spleen for pathological study. Recently, splenectomy has become the more standard procedure for the spleen for both diagnosis and treatment with no recurrence reported after splenectomy.
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Affiliation(s)
- Seifu Alemu
- Jimma University, Institute of Health, Faculty of Medical Sciences, Department of Surgery, Jimma, Ethiopia
| | - Bilisuma Mulatu
- Jimma University, Institute of Health, Faculty of Medical Sciences, Department of Surgery, Jimma, Ethiopia
| | - Abdo Kedir
- Jimma University, Institute of Health, Faculty of Medical Sciences, Department of Pathology, Jimma, Ethiopia
| | - Milkias Minka
- Jimma University, Institute of Health, Faculty of Medical Sciences, Department of Pathology, Jimma, Ethiopia
| | - Workneh Tesfaye
- Jimma University, Institute of Health, Faculty of Medical Sciences, Department of Surgery, Jimma, Ethiopia
| | - Wondu Reta Demissie
- Jimma University, Institute of Health, Faculty of Medical Sciences, Department of Biomedical Sciences, Jimma, Ethiopia.
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Wu Q, Wang M, Zhou M, Miao F, Ni J, Yin Q. Sclerosing Angiomatoid Nodular Transformation of the Spleen: Radiological Findings and Radiological-pathological Correlation. Curr Med Imaging 2024; 20:e260423216201. [PMID: 37170973 DOI: 10.2174/1573405620666230426122828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/20/2023] [Accepted: 03/20/2023] [Indexed: 05/13/2023]
Abstract
Introduction The objective of this study was to describe the CT and MRI features of sclerosing angiomatoid nodular transformation (SANT) of the spleen with pathologic correlation. Materials and Methods Ten patients with surgically resected and pathologically confirmed SANTs were included. Clinical history was reviewed, and gross pathologic, histologic, and immunohistochemical findings were recorded. CT and MRI examinations were evaluated by two radiologists. Results Patients included seven men and three women, with a mean age of 42.9±16.7 years. Pathologic features of SANTs involved multiple angiomatous nodules in a radiating pattern with a central stellate fibrous scar and evidence of hemosiderin deposition. 9 cases showed a lobulated demarcated margin, 8 cases a slight hypoattenuating, 1 isoattenuating, and 1 case with two lesions demonstrated a slight hyperattenuating margin, respectively. Multiple scattered punctate calcifications were involved in 2 cases. 5 cases manifested hypointensity on in-phase imaging, 1 iso-intensity, and 4 iso-hypointensity on out-of-phase imaging. Progressive and centripetal enhancement were exhibited in 10 cases, spoke-wheel pattern in 3 cases, and nodular enhancement in 4 cases, respectively. The central fibrous scar was identified in 8 cases during delayed enhancement. Conclusion Characteristics of SANTs on CT/MRI reflected the underlying pathology. Hypointensity on DWI and T2WI, and change of signal on T1 chemicalshift imaging were found to be due to hemosiderin deposition and fibrous tissue. Typical feature was a solitary, round, lobulated mass with a fibrous scar. Progressive and centripetal enhancement, spoke-wheel pattern, nodular enhancement, and delayed enhancement of central fibrous scar were observed.
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Affiliation(s)
- Qingyang Wu
- Department of Radiology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Mingliang Wang
- Department of Radiology, ZhongShan Hospital, Fudan University, Shanghai, China
| | - Ming Zhou
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Fei Miao
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianming Ni
- Department of Radiology, The Affiliated Second Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Qihua Yin
- Department of Radiology, Shanghai Pudong New Area People's Hospital, Shanghai, China
- Department of Radiology, The Affiliated Second Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China
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Auerbach A, Girton M, Aguilera N. Controversies in the Spleen: Histiocytic, Dendritic, and Stromal Cell Lesions. Surg Pathol Clin 2023; 16:385-400. [PMID: 37149364 DOI: 10.1016/j.path.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Histiocytic, dendritic, and stromal cell lesions that occur in the spleen are challenging diagnostically, not well studied due to their rarity, and therefore somewhat controversial. New techniques for obtaining tissue samples also create challenges as splenectomy is no longer common and needle biopsy does not afford the same opportunity for examination of tissue. Characteristic primary splenic histiocytic, dendritic, and stromal cell lesions are presented in this paper with new molecular genetic findings in some entities that help differentiate these lesions from those occurring in non-splenic sites, such as soft tissue, and identify possible molecular markers for diagnosis.
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Affiliation(s)
| | - Mark Girton
- University of Virginia Health System, Charlottesville, VA, USA
| | - Nadine Aguilera
- University of Virginia Health System, Charlottesville, VA, USA.
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Tan M, Low HM, Shelat V, Tan CH. Imaging patterns in non-traumatic spleen lesions in adults-a review. Jpn J Radiol 2022; 40:664-677. [PMID: 35099683 DOI: 10.1007/s11604-022-01250-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/17/2022] [Indexed: 02/05/2023]
Abstract
The spleen is a complex organ involved in multiple physiological processes in the human body. Elective splenectomy is an uncommon operation, and the precise characterization of the lesion should be achieved to determine the risks and benefits of this operation accurately. Given the significant role of the spleen in homeostasis and the potential risks of the surgery itself and following sequelae such as infection susceptibility, accurate recognition, and classification of splenic lesions is required before surgery. This review provides an overview of malignant (e.g., lymphoma, angiosarcoma) and benign (e.g., cysts, hemangioma, hamartoma) splenic lesions that may warrant an elective splenectomy. Images from a cohort of adult patients undergoing isolated splenectomy for non-traumatic indications in a single center are provided. This review highlights the considerable overlap in imaging patterns between splenic lesions, splenic lesions masquerading as lesions in other organs, increased detection of asymptomatic splenic incidentalomas due to improvements in imaging modalities. This review also provides clinical correlations for each lesion, providing additional information to help clinicians differentiate between lesions and accurately identify diseases amenable to surgical management.
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Affiliation(s)
| | - Hsien Min Low
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishalkumar Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Cher Heng Tan
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
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Tseng H, Ho CM, Tien YW. Reappraisal of surgical decision-making in patients with splenic sclerosing angiomatoid nodular transformation: Case series and literature review. World J Gastrointest Surg 2021; 13:848-858. [PMID: 34512908 PMCID: PMC8394383 DOI: 10.4240/wjgs.v13.i8.848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many clinicians and surgeons are unfamiliar with the sclerosing angiomatoid nodular transformation (SANT), which is gaining recognition as a benign splenic tumor. We challenge that SANT is rare and whether surgical intervention could be avoided through critical imaging review.
AIM To evaluate the incidence of SANT among splenic tumors and the decision-making process of SANT management.
METHODS Twenty hospitalized patients who underwent splenectomy in 2018 and 2019 in a tertiary university hospital were retrospectively reviewed, and their data on imaging, diagnosis, surgical indications, and courses were recorded. All pathology results were confirmed by pathologist. Discriminative features differentiating SANT from other non-SANT splenic tumors were descriptively analyzed in this case series.
RESULTS Fourteen out of 20 patients who underwent splenectomy had splenic tumors, including 3 SANTs (21% splenic tumors), 6 non-SANT benign lesions (43%), 2 metastatic tumors, and 3 lymphomas. Hypointensity on T2-weighted magnetic resonance imaging (MRI), spoke wheel enhancing pattern in contrasted computed tomography or MRI, and cold spot (low fluorodeoxyglucose uptake) in positron emission tomography (PET) scan helped establish the diagnosis of SANT. Lymphoma, presenting with a hot spot on the PET scan were differentiated from SANT. Surgical indications were reformatted for splenic tumors. Splenectomy need not be performed in patients with typical imaging features of SANT.
CONCLUSION SANT is not a rare disease entity in clinical practice. Splenectomy should not be routinely indicated as the only management option for SANT with typical imaging features.
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Affiliation(s)
- Hao Tseng
- School of Medicine, National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Medical Education, and Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
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A Splenic IgG4+ Sclerosing Angiomatoid Nodular Transformation (SANT) Treated by Hemisplenectomy: A Radiologic, Histochemical, and Immunohistochemical Study. Appl Immunohistochem Mol Morphol 2021; 28:e40-e46. [PMID: 28777155 DOI: 10.1097/pai.0000000000000560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Sclerosing angiomatoid nodular transformation (SANT) is a rare benign lesion of unknown origin for which total splenectomy is the standard treatment. CASE PRESENTATION A 54-year-old man with a history of recurrent pancreatitis, bicuspid aortic valve, and aortic dissection underwent abdominal ultrasound, Computed tomography and magnetic resonance imaging, which revealed a 6-cm hypoechoic splenic mass diagnosed as cavernous hemangioma. Owing to his relevant past history, he was considered eligible for emisplenectomy and not for total excision, which is associated with long-term risks, especially infections. RESULTS Histologic examination revealed several nodules of varying size separated by sclerotic stroma with scattered inflammatory cells rich in IgG4+ in a background of splenic red pulp. Immunohistochemical stains showed a characteristic panel for CD34, CD31, and CD8. CONCLUSIONS The diagnosis of SANT should be considered in any patient presenting with a splenic lesion containing an angiomatoid or inflammatory component. The only method able to establish a correct diagnosis is histologic and immunohistochemical evaluation. Complete splenectomy is generally considered the best approach. However, if the patient is at high risk of infection and localization of the lesion allows for selective devascularization of the affected part of the spleen, the lesion could be removed by hemisplenectomy. In some patients SANT is related to high blood levels of IgG4. Thus, corticosteroids might be useful for treating IgG4+ SANT and for preventing other IgG4-related diseases.
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Sanmoto Y, Ishimaru T, Hayashi K, Tomita O, Oshima K, Nakazawa A, Koh K, Kawashima H. Sclerosing angiomatoid nodular transformation in a child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Sangiorgio VFI, Arber DA. Non-hematopoietic neoplastic and pseudoneoplastic lesions of the spleen. Semin Diagn Pathol 2021; 38:159-164. [DOI: 10.1053/j.semdp.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 01/04/2023]
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Jin Y, Hu H, Regmi P, Li F, Cheng N. Treatment options for sclerosing angiomatoid nodular transformation of spleen. HPB (Oxford) 2020; 22:1577-1582. [PMID: 32063479 DOI: 10.1016/j.hpb.2020.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND To summarise the clinical features of Sclerosing angiomatoid nodular transformation (SANT) of the spleen and to compare the efficacy of three different surgical treatments. METHODS We performed a retrospective analysis of patients with SANT of spleen treated at our center from 2009 to 2018. We compared the efficacy and safety of three different types of surgical procedures. ANOVA and the chi-square test were used for statistical analysis. RESULTS A total of 37 patients were included. Most (35/37; 94.6%) were asymptomatic. A number presented as obscure boundary lesions such that malignancy could not be excluded. Open splenectomy was performed for 12 patients, laparoscopic splenectomy for 12 patients and laparoscopic partial splenectomy for 13 patients. Operation time (P = 0.355), blood loss (P = 0.135), length of hospital stay after operation (P = 0.271) and postoperative complications (P = 0.502) were comparable between the three groups. Duration of drainage tube placement was significantly longer in laparoscopic partial splenectomy patients (P = 0.006). Peak platelet count after operation was significantly lower in laparoscopic partial splenectomy patients (P < 0.001). CONCLUSION Laparoscopic partial splenectomy appears to be a technically feasible and therapeutically effective approach for SANT.
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Affiliation(s)
- Yanwen Jin
- Department of Biliary Surgery, West China Hospital, Sichuan University, PR China
| | - Hajie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, PR China
| | - Parbatraj Regmi
- Department of Biliary Surgery, West China Hospital, Sichuan University, PR China
| | - Fuyu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, PR China
| | - Nansheng Cheng
- Department of Biliary Surgery, West China Hospital, Sichuan University, PR China.
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Sánchez Belmar C, White A, Majeed M, Redmond HP. Sclerosing angiomatoid nodular transformation of the spleen: unusual case presentation in an intravenous drug user. BMJ Case Rep 2020; 13:13/6/e235648. [PMID: 32565440 DOI: 10.1136/bcr-2020-235648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
An unusual presentation of sclerosing angiomatoid nodular transformation in a 42-year-old man who was admitted with jaundice, deranged liver function tests and subsequently diagnosed with acute hepatitis C infection in the context of recent intravenous drug use. During his admission, he had an ultrasound of the abdomen followed by a CT thorax, abdomen and pelvis which showed splenomegaly and a large splenic lower pole mass that was hypoechoic and concerning for lymphoma. A bone marrow biopsy showed no evidence of lymphoma and an ultrasound-guided biopsy of the splenic mass suggested unusual features with vascular proliferation, either neoplastic or reactive, with no evidence of lymphoma or high-grade sarcoma. Given the concern for malignancy, an open splenectomy was required to determine the nature of the lesion with histologic findings consistent with a non-neoplastic benign vascular lesion favouring sclerosing angiomatoid nodular transformation.
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Affiliation(s)
| | - Alexandra White
- Department of Cardiothoracic Surgery, Galway University Hospital, Galway, Ireland
| | - Mudassar Majeed
- Department of Breast and Endocrine Surgery, Cork University Hospital Group, Cork, Ireland
| | - Henry Paul Redmond
- Department of General Surgery, Cork University Hospital Group, Cork, Ireland
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Capaldi M, Fransvea P, Ricci G, Stella F, Trombetta S, Cerasari S, Cataldi C, Casale S, Marini P. Sclerosing angiomatoid nodular transformation (SANT) of spleen mimicking a splenic abscess: Case report and review of the literature. Int J Surg Case Rep 2019; 56:1-4. [PMID: 30798093 PMCID: PMC6389552 DOI: 10.1016/j.ijscr.2019.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/10/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION SANT of the spleen is a benign lesion that does not recur after splenectomy with unknown etiology. PRESENTATION OF THE CASE We report a case of sclerosing angiomatoid nodular transformation (SANT) of the spleen mimicking a splenic abscess in a patient with imaging studies that failed to differentiate this lesion from other splenic lesions. DISCUSSION SANT of the spleen is a rare condition, with only less than 100 cases reported in the literature. Clinically, SANT is only a kind of described pathological diagnostic conception. As in our case, these splenic lesions are often incidental findings on imaging studies performed for other reasons. CONCLUSION The patient was treated with splenectomy, which has proved to be both diagnostic and therapeutic. Although histology can lead to the diagnosis of vascular tumor, immunohistochemistry is the only way to confirm the diagnosis.
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Affiliation(s)
- Massimo Capaldi
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
| | - Pietro Fransvea
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy; Faculty of Medicine and Psychology, "Sapienza" University of Rome, St. Andrea's Hospital, Italy.
| | - Gabriele Ricci
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
| | | | - Silvia Trombetta
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
| | - Saverio Cerasari
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
| | - Carlo Cataldi
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
| | - Sabrina Casale
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
| | - Pierluigi Marini
- General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
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Sclerosing Angiomatoid Nodular Transformation: Laparoscopic Splenectomy as Therapeutic and Diagnostic Approach at the Same Time. Case Rep Surg 2018; 2018:7020538. [PMID: 29854543 PMCID: PMC5964553 DOI: 10.1155/2018/7020538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/22/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular lesion with unknown etiopathogenesis and with definite features of imaging, histopathology, and immunohistochemistry. It was first described by Martel et al. in 2004, and to date, only 151 cases have been reported. Case Description We report a case of SANT of the spleen detected in a 66-year-old Caucasian, without comorbidities, presented to our department with epigastric pain. We, also, presented a review of the literature. Conclusions SANT is a benign incidentally vascular condition in the majority of cases. The wide age and gender distribution in our review is in accordance with that in previous studies in English literature. In our opinion, splenectomy is the choice treatment because it is at the same time diagnostic and therapeutic in a definitive way.
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Demirci I, Kinkel H, Antoine D, Szynaka M, Klosterhalfen B, Herold S, Janßen H. Sclerosing angiomatoid nodular transformation of the spleen mimicking metastasis of melanoma: a case report and review of the literature. J Med Case Rep 2017; 11:251. [PMID: 28865487 PMCID: PMC5581926 DOI: 10.1186/s13256-017-1400-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/20/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sclerosing angiomatoid nodular transformation is a benign disorder of splenic tissue and is often mistaken as a potentially malignant entity in the diagnostic process. To the best of our knowledge, this is the first report of sclerosing angiomatoid nodular transformation mimicking metastasis of melanoma in the literature. CASE PRESENTATION A 43-year-old white man presented with a newly found splenic mass 4 years ago to our Department of Gastroenterology. He was diagnosed as having a superficial spreading malignant melanoma localized at his left instep 7 years ago and was successfully treated with radical local resection. Several diagnostic procedures were conducted. Ultrasound showed a hypoechoic lesion in the inferior pole of his spleen with a diameter of 2 cm, blurred boundaries, and inhomogeneous interior pattern. Contrast-enhanced ultrasound was inconclusive and showed only discrete contrast enhancement of the lesion with accentuated nodule-like enrichment of the boundaries in the arterial phase. Computed tomography and magnetic resonance imaging scans showed two splenic lesions which were highly suspicious of metastasis. Magnetic resonance imaging of his head was inconspicuous. Bone scintigraphy showed no abnormal results. Fine-needle aspiration indicated metastasis of the above-mentioned malignant melanoma. We conducted a laparoscopic splenectomy. His intraoperative and postoperative course were uneventful. In contrast to the result of the fine-needle aspiration, the presence of metastasis of melanoma could not be confirmed. Histological analysis revealed nodule-like arrangement of fibroblasts with low cell density and a predominance of dilated capillaries, indicating sclerosing angiomatoid nodular transformation of the spleen. CONCLUSIONS There are no preoperative diagnostic imaging procedures which can definitely differentiate sclerosing angiomatoid nodular transformation from malignancies in cases of morphological and immunophenotypic variations of the specimen. Morphological and immunophenotypic variations of the specimen represent a diagnostic challenge and can mimic malignoma. As reported in our case, the specimen obtained by ultrasound-guided fine-needle aspiration led to the diagnosis of metastasis of melanoma. Splenectomy is often conducted due to a splenic mass suspicious of malignoma as described in our case or with unknown valency in different diagnostic imaging procedures.
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Affiliation(s)
- Ilhan Demirci
- Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Düren, Düren, Germany
| | - Horst Kinkel
- Department of Gastroenterology, Hepatology and Diabetology, Hospital of Düren, Düren, Germany
| | - Dirk Antoine
- Department of General, Visceral and Thoracic Surgery, Hospital of Leverkusen, Leverkusen, Germany
| | - Marc Szynaka
- Department of Radiology, Hospital of Düren, Düren, Germany
| | | | - Susanne Herold
- Department of Internal Medicine II, University of Gießen Lung Center, Gießen, Germany
| | - Hermann Janßen
- Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Düren, Düren, Germany
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Matsubara K, Oshita A, Nishisaka T, Sasaki T, Matsugu Y, Nakahara H, Urushihara T, Itamoto T. A case of sclerosing angiomatoid nodular transformation of the spleen with increased accumulation of fluorodeoxyglucose after 5-year follow-up. Int J Surg Case Rep 2017; 39:9-13. [PMID: 28783523 PMCID: PMC5545820 DOI: 10.1016/j.ijscr.2017.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/17/2017] [Accepted: 07/17/2017] [Indexed: 12/16/2022] Open
Abstract
Although sclerosing angiomatoid nodular transformation (SANT) of the spleen is a new entity defined as a benign pathologic lesion, it is very difficult for ruling out the malignancy in preoperative imaging studies. Even when accumulation of fluorodeoxyglucose increased slightly during the follow-up period and suggested the possibility of malignant diseases, it is necessary to make a diagnosis of splenic SANT comprehensively. Introduction Sclerosing angiomatoid nodular transformation (SANT) of spleen is a new entity defined as a benign pathologic lesion. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) shows weak accumulation, thereby ruling out the malignancy in preoperative diagnosis is difficult. Herein, we reported a case of shrinking SANT with increased FDG accumulation during a 5-year follow-up period, which was treated by laparoscopic splenectomy. Presentation of case A 64-year-old female had been referred to our hospital for the evaluation of a splenic tumor. Initial contrast-enhanced computed tomography (CT) showed a well-defined, and ovoid hypoattenuating lesion, measuring 52 mm in diameter in the spleen. Initial PET/CT revealed accumulation of FDG in the tumor (maximum standardized uptake value [SUVmax]: 2.8). The mass was diagnosed as SANT, and the patient was followed-up every 6–12 months for 5 years. Follow-up PET/CT revealed increased accumulation of FDG (SUVmax: 3.5). As it was suspicious considering the differential diagnosis, including malignant lymphoma and inflammatory pseudotumor, she underwent laparoscopic splenectomy. The pathological results showed three types of vessels including capillaries, ectatic small veins, and sinusoids-like vessels, consistent with the features of SANT. Discussion A SANT may have features that resemble those of malignancy, including the growing mass and the increase of FDG accumulation. Conclusion Although the preoperative diagnosis of SANT is difficult, it is necessary to make a diagnosis of SANT comprehensively, even when accumulation of FDG increased slightly during the follow-up period and suggested the possibility of malignant diseases.
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Affiliation(s)
- Keiso Matsubara
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan
| | - Akihiko Oshita
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Japan.
| | - Takashi Nishisaka
- Department of Pathology Clinical Laboratory, Hiroshima Prefectural Hospital, Japan
| | - Tamito Sasaki
- Department of Internal Medicine, Hiroshima Prefectural Hospital, Japan
| | - Yasuhiro Matsugu
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan
| | - Hideki Nakahara
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan
| | - Takashi Urushihara
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Toshiyuki Itamoto
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Japan
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Atas H, Bulus H, Akkurt G. Sclerosing Angiomatoid Nodular Transformation of the Spleen: An uncommon Cause of Abdominal Pain. Euroasian J Hepatogastroenterol 2017; 7:89-91. [PMID: 29201782 PMCID: PMC5663784 DOI: 10.5005/jp-journals-10018-1221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/30/2016] [Indexed: 11/23/2022] Open
Abstract
Sclerosing angiomatoid nodular transformation (SANT) is a rare and benign lesion arising from the red pulp of the spleen, with an unknown etiopathogenesis. These tumors are usually asymptomatic or cause nonspecific abdominal pain. Most SANTs are found incidentally on radiographic examination, or during surgery for an unrelated condition. Therefore, high clinical suspicion is of great importance for the diagnosis. Splenectomy provides complete cure, and no recurrence and/or malignant transformation was reported to date. In this study, a rare case of SANT was reported in a young adult male, and was discussed with the relevant literature. How to cite this article: Atas H, Bulus H, Akkurt G. Sclerosing Angiomatoid Nodular Transformation of the Spleen: An uncommon Cause of Abdominal Pain. Euroasian J Hepato-Gastroenterol 2017;7(1):89-91.
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Affiliation(s)
- Hakan Atas
- Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Hakan Bulus
- Department of General Surgery Kecioren Training and Research Hospital, Ankara, Turkey
| | - Göhan Akkurt
- Department of General Surgery Kecioren Training and Research Hospital, Ankara, Turkey
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Lim HTG, Tan CH, Teo LT, Ho CSB. Multimodality imaging of splenic sclerosing angiomatoid nodular transformation. Singapore Med J 2016; 56:e96-9. [PMID: 26106250 DOI: 10.11622/smedj.2015070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sclerosing angiomatoid nodular transformation (SANT) is an exceedingly rare, benign and proliferative vascular lesion that arises from the splenic red pulp. It is often an incidental finding on imaging. The diagnosis of SANT is confirmed via histopathological examination of the resected spleen. Herein, we present a case of SANT and describe its typical imaging characteristics. An asymptomatic 39-year-old man was found to have a 3.1 cm × 2.7 cm × 2.3 cm hypoechoic splenic lesion during abdominal ultrasonography, which was performed to investigate his elevated gamma-glutamyl transpeptidase and alanine transaminase levels. Contrast-enhanced computed tomography suggested a vascular splenic lesion, while magnetic resonance imaging demonstrated features consistent with SANT. In view of the increasing size of the lesion on follow-up imaging, the patient elected for splenectomy. Histopathological examination confirmed SANT, and the lesion was completely resected by laparoscopic splenectomy.
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Affiliation(s)
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Li Tserng Teo
- Trauma and Acute Care Surgery, Department of Surgery, Tan Tock Seng Hospital, Singapore ; Surgical High Dependency Unit, Division of Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Eusébio M, Sousa AL, Vaz AM, Gomes da Silva S, Milheiro MA, Peixe B, Caldeira P, Guerreiro H. A case of sclerosing angiomatoid nodular transformation of the spleen: Imaging and histopathological findings. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:600-603. [DOI: 10.1016/j.gastrohep.2015.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/05/2015] [Accepted: 09/09/2015] [Indexed: 12/28/2022]
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Ricci ZJ, Mazzariol FS, Flusberg M, Chernyak V, Oh SK, Kaul B, Stein MW, Rozenblit AM. Improving diagnosis of atraumatic splenic lesions, part II: benign neoplasms/nonneoplastic mass-like lesions. Clin Imaging 2016; 40:691-704. [DOI: 10.1016/j.clinimag.2016.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/16/2016] [Accepted: 02/03/2016] [Indexed: 02/07/2023]
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Yoshimura N, Saito K, Shirota N, Suzuki K, Akata S, Oshiro H, Nagao T, Sugimoto K, Tsuchida A, Tokuuye K. Two cases of sclerosing angiomatoid nodular transformation of the spleen with gradual growth: usefulness of diffusion-weighted imaging. Clin Imaging 2014; 39:315-7. [PMID: 25457575 DOI: 10.1016/j.clinimag.2014.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/30/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
Sclerosing angiomatoid nodular transformation (SANT) is a recently recognized and rare, nonneoplastic lesion of the spleen. Some papers have reported an increased SANT diameter during the follow-up period. We present two cases of SANT whose size increased during the follow-up period. Diffusion-weighted magnetic resonance imaging (DWI) findings correlated well with the pathological findings of SANT, the multinodular high-intensity area as the angiomatoid nodules and the peripheral low-intensity area as fibrous tissues. Therefore, DWI may be a useful imaging tool.
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Affiliation(s)
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Tokyo, Japan.
| | | | - Kunihito Suzuki
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Soichi Akata
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Hisashi Oshiro
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | | | - Koichi Tokuuye
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
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Park JH, Hwang SH, Kim KC, Kim SY, Song GW, Han JH, Park JS. A Case of Sclerosing Angiomatoid Nodular Transformation of the Spleen: Spoke Wheel Pattern on Computed Tomography. ACTA ACUST UNITED AC 2014. [DOI: 10.3904/kjm.2014.86.3.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Joo Han Park
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Sun Hyuk Hwang
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Ki Chan Kim
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Si Yeon Kim
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Ga Won Song
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Ho Han
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Joon Seong Park
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
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Pradhan D, Mohanty SK. Sclerosing angiomatoid nodular transformation of the spleen. Arch Pathol Lab Med 2013; 137:1309-12. [PMID: 23991745 DOI: 10.5858/arpa.2012-0601-rs] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sclerosing Angiomatoid Nodular Transformation (SANT) of the spleen is a rare benign lesion of the spleen with unknown etiology. SANT is classically considered to be a female-predominant disease, with most of the patients in the 30- to 60-year age group. Most lesions are found incidentally on imaging. Although SANT has specific imaging findings, the differential diagnosis from other splenic tumors or malignant lesions is very difficult. Histopathologically, these tumors reveal multiple confluent angiomatoid nodules; these nodules are surrounded by concentric collagen fibers exhibiting an inflammatory and myofibroblastic response and are accompanied by numerous erythrocytes and siderophages. The nodules are populated by endothelial cells, phenotypically recapitulating normal splenic vasculature, such as sinusoids, capillaries, and small veins. Nuclear atypia is minimal, mitotic figures are extremely rare, and necrosis is consistently absent. This lesion has a unique immunohistochemical profile characterized by CD34(-)CD31(+)CD8(+) sinusoids, CD34(+)CD31(+)CD8(-) capillaries, and CD34(-)CD31(+)CD8(-) small veins. CD68 is positive in macrophages. Splenectomy is a useful and effective technique for the management of SANT. SANT patients have a good prognosis, with no recurrence after splenectomy. In this review, we discuss the current knowledge of SANT of the spleen and its clinical relevance.
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Sclerosing angiomatoid nodular transformation of the spleen: CT and MRI features with pathologic correlation. AJR Am J Roentgenol 2013; 200:W353-60. [PMID: 23521478 DOI: 10.2214/ajr.12.9522] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective of this study was to describe the CT and MRI features of sclerosing angiomatoid nodular transformation of the spleen with pathologic correlation. MATERIALS AND METHODS Nine patients with surgically resected and pathologically confirmed sclerosing angiomatoid nodular transformation were included in the study. Clinical history was reviewed to determine patient demographics and symptoms at presentation. Gross pathologic, histologic, and immunohistochemical findings were recorded. CT (n = 9) and MRI (n = 4) examinations were evaluated for lesion shape and margins, intrinsic characteristics, and enhancement pattern. RESULTS Patients included were six women and three men, with a mean age of 41.2 years. Pathologic features of sclerosing angiomatoid nodular transformation included multiple angiomatous nodules in a radiating pattern with a central stellate fibrous scar and evidence of hemosiderin deposition. On imaging, the lesions were solitary and round, 78% having a lobulated margin. They were heterogeneously hypoenhancing during the arterial and portal venous phases of contrast-enhanced CT or MRI, with peripheral enhancing radiating lines in 88% of lesions. They showed progressive enhancement and were isoenhancing or hyperenhancing in the delayed phase. A hypoenhancing central scar was shown on imaging in 22% of lesions. All lesions were hypointense on T2-weighted images. CONCLUSION Sclerosing angiomatoid nodular transformation shows characteristic CT and MRI findings reflecting the underlying pathology. Typical features are a solitary, round, lobulated mass with early peripheral enhancing radiating lines and progressive enhancement of the angiomatous nodules; delayed enhancement of the fibrous tissue; and hypo-intense T2 signal intensity from hemosiderin deposition.
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Kim HH, Hur YH, Koh YS, Kim JC, Kim HJ, Kim JW, Kim Y, Lee JH, Cho CK. Sclerosing angiomatoid nodular transformation of the spleen related to IgG4-associated disease: report of a case. Surg Today 2013; 43:930-6. [PMID: 23440358 DOI: 10.1007/s00595-013-0499-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 03/30/2012] [Indexed: 10/27/2022]
Abstract
Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular mass, with fewer than 100 cases documented. It is generally recognized as a vascular lesion that develops in the red pulp of the spleen; however, its pathogenesis is not clearly defined. We report a case of SANT of the spleen, which presents evidence to support the hypothesis that this disease entity is associated with IgG4-associated disease. Microscopically, the tumor was composed of multiple vascular structures separated by fibrous connective tissue and immunohistochemical examination revealed positive staining for CD31, CD34, factor VIII, and IgG4. Further research based on large number of cases is warranted to clarify the pathogenesis of this tumor.
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Affiliation(s)
- Ho-Hyun Kim
- Department of Surgery, Chonnam National University Medical School, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Gwangju, Jeollanam-do, 519-763, Korea.
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25
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Mohr Z, Klippel S, Spiethoff A, Trick D, Willis S. [Laparoscopic splenectomy for sclerosing angiomatoid nodular transformation]. Chirurg 2012; 82:714-8. [PMID: 21290093 DOI: 10.1007/s00104-010-2045-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sclerosing angiomatoid nodular transformation (SANT) is a benign lesion of the spleen which can be cured by splenectomy. In the literature about 45 cases have been reviewed. Although it is defined by the morphological details, data regarding surgical therapy are scarce. To the best of our knowledge, a laparoscopic approach has not been published before. We investigated in one case of SANT the feasibility of a laparoscopic approach. Histological investigations confirmed the diagnosis of a SANT which was resected in toto. This report shows that the laparoscopic splenectomy is a feasible, safe and effective method for treatment of SANT.
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Affiliation(s)
- Z Mohr
- Chirurgische Klinik A, Allgemein-, Viszeral-, Thorax- und Unfallchirurgie, Klinikum der Stadt Ludwigshafen, Bremserstrasse 79, Ludwigshafen, Germany.
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26
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Ambrosio MR, Rocca BJ, Di Mari N, Ambrosio A, Lazzi S. Multifocal Capillary Hemangioma (Hemangiomatosis) of the Spleen. TUMORI JOURNAL 2012; 98:e22-6. [DOI: 10.1177/030089161209800133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The spleen is mainly affected by benign tumors that originate from the vascular endothelium. The most common is hemangioma, which presents as a small, localized lesion. Isolated diffuse hemangiomatosis of the spleen is a rare entity in which the entire splenic parenchyma is replaced by a proliferation of neoplastic blood vessels. Here we illustrate the case of a 26-year-old man presenting with splenomegaly due to diffuse hemangiomatosis of the white pulp who underwent a splenectomy. Methods Representative samples of the spleen were stained with hematoxylin and eosin, and immunohistochemical analysis was performed for Mib-1, CD20, CD30, CD15, CD34, CD31, CD8, factor VIII, D2–40, CD68PGM1, and LMP1. Results Macroscopically, the splenic parenchyma contained multiple, red-brown nodules ranging from 0.4 to 1.5 cm. Microscopically, the nodules were roundish and confluent with an angiomatoid appearance and high positivity for CD34 and factor VIII, while they were negative for D2–40. Conclusions The differential diagnosis of splenic tumors includes lymphangioma, lymphangiomatosis, peliosis, littoral cell angioma, hemangioendothelioma, hamartoma, angiomatoid transformation of the spleen, and angiosarcoma. It is debated whether diffuse hemangiomatosis is a malformation of the postsinusoidal venous system or a slowly growing neoplasm arising from the splenic sinuses. The positivity of the cavernous vessels for CD8 seems to be in favor of the malformative nature of the tumor.
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Affiliation(s)
- Maria Raffaella Ambrosio
- Department of Human Pathology and Oncology, Section of Anatomic Pathology, University of Siena, Siena
| | - Bruno Jim Rocca
- Department of Human Pathology and Oncology, Section of Anatomic Pathology, University of Siena, Siena
| | | | | | - Stefano Lazzi
- Department of Human Pathology and Oncology, Section of Anatomic Pathology, University of Siena, Siena
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27
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Burneo Esteves M, Franco Herrera R, Castro Álvarez Y, Pérez Díaz D, Turégano Fuentes F. [Sclerosing angiomatoid nodular transformation (SANT) of the spleen. A very uncommon tumour]. Cir Esp 2011; 90:607-9. [PMID: 22015227 DOI: 10.1016/j.ciresp.2011.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 05/11/2011] [Accepted: 05/12/2011] [Indexed: 11/17/2022]
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Thacker C, Korn R, Millstine J, Harvin H, Van Lier Ribbink JA, Gotway MB. Sclerosing angiomatoid nodular transformation of the spleen: CT, MR, PET, and ⁹⁹(m)Tc-sulfur colloid SPECT CT findings with gross and histopathological correlation. ACTA ACUST UNITED AC 2011; 35:683-9. [PMID: 19862569 PMCID: PMC2980627 DOI: 10.1007/s00261-009-9584-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sclerosing angiomatoid nodular transformation (SANT) is a benign, proliferative vascular lesion affecting the spleen. Few reports detailing the cross sectional and PET appearance of this lesion are available, and the lesion’s behavior with 99mTc-sulfur colloid scintigraphy is previously unreported. Sclerosing nodular transformation of the spleen shows increased tracer accumulation on positron emission tomography, and a central scar-like appearance with an enhancing capsule and radiating septae on CT and MR studies that reflects the gross and histopathological features of the lesion may be visible. An understanding of this pathological finding may allow prospective recognition of the sclerosing nodular transformation of the spleen on cross sectional imaging studies.
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29
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Sitaraman LM, Linn JG, Matkowskyj KA, Wayne JD. Sclerosing angiomatoid nodular transformation of the spleen masquerading as a sarcoma metastasis. Rare Tumors 2010; 2:e45. [PMID: 21234247 PMCID: PMC3019590 DOI: 10.4081/rt.2010.e45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 06/09/2010] [Accepted: 06/29/2010] [Indexed: 12/14/2022] Open
Abstract
We report a case of sclerosing angiomatoid nodular transformation (SANT) of the spleen presenting as an incidental splenic mass in a patient with a history of retroperitoneal spindle cell sarcoma. Imaging studies and preoperative fine needle biopsy failed to differentiate this lesion from other vascular splenic lesions or a metastatic focus of a prior sarcoma. The patient was treated with splenectomy, which has proved both diagnostic and therapeutic in this and other cases of SANT. Although histology can lead to the diagnosis of vascular tumor, immunohistochemistry is the only way to confirm the diagnosis of SANT. The etiology of SANT is unknown. SANT of the spleen is a benign lesion that does not recur after splenectomy.
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30
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Sitaraman LM, Linn JG, Matkowskyj KA, Wayne JD. Sclerosing angiomatoid nodular transformation of the spleen masquerading as a sarcoma metastasis. Rare Tumors 2010; 2:e46. [PMID: 21139961 PMCID: PMC2994526 DOI: 10.4081/rt.2010.e46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 06/09/2010] [Accepted: 06/29/2010] [Indexed: 11/23/2022] Open
Abstract
We report a case of sclerosing angiomatoid nodular transformation (SANT) of the spleen presenting as an incidental splenic mass in a patient with a history of retroperitoneal spindle cell sarcoma. Imaging studies and preoperative fine needle biopsy failed to differentiate this lesion from other vascular splenic lesions or a metastatic focus of a prior sarcoma. The patient was treated with splenectomy, which has proved both diagnostic and therapeutic in this and other cases of SANT. Although histology can lead to the diagnosis of vascular tumor, immunohistochemistry is the only way to confirm the diagnosis of SANT. The etiology of SANT is unknown. SANT of the spleen is a benign lesion that does not recur after splenectomy.
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31
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Stanislas S. [Splenic pathology. Case 6. Inflammatory pseudo-tumour]. Ann Pathol 2010; 30:228-32. [PMID: 20621602 DOI: 10.1016/j.annpat.2010.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 02/24/2010] [Indexed: 11/16/2022]
Affiliation(s)
- Sophie Stanislas
- Département de pathologie, hôpital Haut-Lévêque, CHU-Université de Bordeaux, Pessac, France.
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32
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Affiliation(s)
- Fabio Facchetti
- Department of Pathology, University of Brescia, Brescia, Italy.
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33
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[A tumor of the spleen]. Ann Pathol 2009; 29:512-4. [PMID: 20005443 DOI: 10.1016/j.annpat.2009.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2009] [Indexed: 11/21/2022]
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[Sclerosing angiomatoid nodular transformation of the spleen]. ACTA ACUST UNITED AC 2009; 90:1755-8. [PMID: 19953066 DOI: 10.1016/s0221-0363(09)73277-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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35
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Langer R, Dinges J, Dobritz M, Brauer RB, Perren A, Becker K, Kremer M. Sclerosing angiomatoid nodular transformation of the spleen presenting as a rapidly growing tumour in a patient with rectal cancer. BMJ Case Rep 2009; 2009:bcr11.2008.1191. [PMID: 21918654 DOI: 10.1136/bcr.11.2008.1191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A patient with rectal cancer developed a rapidly growing splenic mass 2 years after cancer treatment. Since a metastatic process could not be ruled out, splenectomy was performed, and the tumour emerged as a sclerosing angiomatoid nodular transformation (SANT) of the spleen. SANT is a rare, recently recognised, non-neoplastic vascular lesion of the spleen that radiologically may be difficult to distinguish from vascular splenic lesions such as splenic hamartoma, haemangioma or littoral cell angioma. However, morphologically and immunohistochemically it is separated from those tumours by its unique nodular angiomatoid proliferation pattern. SANT is considered to be a benign lesion. This case is reported because of its important clinical impact for the differential diagnosis of splenic masses. Data regarding growth rates of these lesions are scarce and a growth progression as in this case, that finally led to the indication for splenectomy due to lingering suspicion of malignancy, is novel.
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Affiliation(s)
- Rupert Langer
- Institute of Pathology, Technische Universität München, Trogerstrasse 18, Munich, 81675, Germany
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36
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Koreishi AF, Saenz AJ, Fleming SE, Teruya-Feldstein J. Sclerosing Angiomatoid Nodular Transformation (SANT) of the Spleen: A Report of 3 Cases. Int J Surg Pathol 2009; 17:384-9. [DOI: 10.1177/1066896909342568] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The authors describe 3 cases of sclerosing angiomatoid nodular transformation (SANT) of the spleen diagnosed at Memorial Sloan-Kettering Cancer Center within a 1-year period (July 2008 to June 2009). All patients were female, older than 50, with lesions ranging in size from 2 to 4 cm. All were alive and well after splenectomy. All the cases showed characteristic histological and immunophenotypical findings as previously described in the literature, including scattered IgG4positive plasma cells in the fibrosclerotic stroma. Of the 3 patients, 2 had a history of carcinoma, and metastasis was of concern, but a PET scan in one of these patients showed minimal to absent FDG activity suggesting that this process was of a benign indolent nature. However, in 1 patient, a PET scan revealed positive FDG activity, heightening clinical concern for malignancy.
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Affiliation(s)
| | - Adam J. Saenz
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Stephen E. Fleming
- Department of Radiology Memorial Sloan-Kettering Cancer Center, New York
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38
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Abstract
Splenic hamartoma is a rare, benign vascular proliferation that is often found incidentally while working up other complaints or at autopsy. Women more commonly present with symptoms related to mass effect than men. Histologic findings consist of unorganized vascular channels of varying width, with intervening red pulp-like disorganized stroma with or without lymphoid follicles. The endothelial cells are similar to those of normal splenic sinuses. Although rendering a diagnosis can be difficult, endothelial cells that are positive for CD8 are a key feature that differentiate hamartoma from other vascular lesions of the spleen. Clinical, radiologic, and histologic correlation is essential to ensure this benign lesion is not mistaken for malignancy.
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Affiliation(s)
- Hwajeong Lee
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA.
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39
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El Demellawy D, Nasr A, Alowami S. Sclerosing angiomatoid nodular transformation of the spleen: case report. Pathol Res Pract 2009; 205:289-93. [PMID: 19171438 DOI: 10.1016/j.prp.2008.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2007] [Revised: 03/07/2008] [Accepted: 12/08/2008] [Indexed: 02/07/2023]
Abstract
Sclerosing angiomatoid transformation of the spleen (SANT) is a relatively new, rare, and unique lesion that involves the spleen. Less than 30 cases have been described to date. The lesion commonly affects middle-aged adults and shows a female predilection. It is often discovered incidentally through imaging. SANT is morphologically and immunohistochemically distinct. However, as it is a relatively new entity, misdiagnosis of SANT may lead to overtreatment of the patients. The pathogenesis of SANT is unknown. The lesion is entirely benign, and splenectomy is curative. We report a new case of SANT, with emphasis on the differential diagnosis and pathogenesis of SANT.
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Affiliation(s)
- Dina El Demellawy
- Northern Ontario School of Medicine, William Osler Health Care, Pathology and Laboratory Medicine, 2301 Salcome Drive, Oakville, Ontario, Canada.
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40
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[Sclerosing angiomatoid nodular transformation of the spleen (SANT): a case report]. Ann Pathol 2008; 28:321-3. [PMID: 18928875 DOI: 10.1016/j.annpat.2008.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2008] [Indexed: 02/07/2023]
Abstract
We report a case of sclerosing angiomatoid nodular transformation of the spleen incidently discovered in a 41-year-old man. The macroscopic examination showed the presence of a reddish brown, well delineated but not encapsulated, multinodular lesion being histologically characterized by nodules made up of complex vascular structures lined by monomorphous but non atypical endothelial cells, surrounded by fibrin and a collagen stroma rich in spumous macrophages and hemosiderophages. The immunohistochemical markers carried out showed the presence of capillaries, veins and sinusoids normally found within the splenic parenchyma, but adopting an unusual configuration. This distinct entity, recently described and completely benign, must be included in the differential diagnosis of the vascular lesions of the spleen, which includes, among others, the hemangioma, the littoral cell angioma, the hemangioendothelioma and the inflammatory myofibroblastic tumor.
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