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(8): 848-858 [PMID: 34512908 DOI: 10.4240/wjgs.v13.i8.848]
Corresponding Author of This Article
Cheng-Maw Ho, MD, PhD, Associate Professor, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei 100, Taiwan. miningho@ntu.edu.tw
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Aug 27, 2021; 13(8): 848-858 Published online Aug 27, 2021. doi: 10.4240/wjgs.v13.i8.848
Reappraisal of surgical decision-making in patients with splenic sclerosing angiomatoid nodular transformation: Case series and literature review
Hao Tseng, Cheng-Maw Ho, Yu-Wen Tien
Hao Tseng, School of Medicine, National Taiwan University College of Medicine, Taipei 100, Taiwan
Hao Tseng, Department of Medical Education, and Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
Cheng-Maw Ho, Yu-Wen Tien, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
Author contributions: Tseng H drafted the manuscript; Tseng H and Ho CM designed the study; Tseng H conducted data processing; Tseng H, Ho CM and Tien YW performed data analysis; Ho CM and Tien YW were the directors responsible for general organization and instruction; all authors have read and agreed to the published version of the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of the National Taiwan University Hospital, Taipei, Taiwan (NTUH REC: 202102011RIND).
Informed consent statement: Because this was a retrospective study using chart review, the institutional review board waived the need for informed consent.
Conflict-of-interest statement: Tseng H, Ho CM and Tien YW all declare no conflict of interest.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cheng-Maw Ho, MD, PhD, Associate Professor, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei 100, Taiwan. miningho@ntu.edu.tw
Received: April 13, 2021 Peer-review started: April 13, 2021 First decision: June 23, 2021 Revised: June 28, 2021 Accepted: July 19, 2021 Article in press: July 19, 2021 Published online: August 27, 2021
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.
Core Tip: Sclerosing angiomatoid nodular transformation (SANT) used to be considered a rare but benign lesion since it was recognized. However, SANT comprised one fifth patients who received splenectomy for splenic tumors in our university hospital cohort. The unique diagnostic image features of SANT include spoke wheel enhancing pattern in contrasted computed tomography or magnetic resonance imaging (MRI) and hypo-intensity on T2-weighted images of MRI. Clinicians should recognize this disease entity to avoid unnecessary overtreatment.
