Purpose
To retrospectively review the patients diagnosed with rare Splenic pathology, Sclerosing Angiomatoid Nodular Transformation.
Present literature review of the imaging features of the Pubmed published articles between 2011-2020
Based on the imaging findings, propose conservative management of the patients with Splenic SANT to avoid unnecessary splenectomy.
Methods and materials
Splenic vascular neoplasms are the most common splenic neoplasms from benign such as haemangiomas, hamartomas, and lymphangiomas to frankly malignant i.e., angiosarcoma.
Splenic sclerosing angiomatoid nodular transformation, also known as multinodular haemangioma was first reported by Martel et al. in 2004. It is an uncommon lesion originating from the red pulp of the spleen and depicts angiomatoid nodules under the microscope.
The exact pathogenesis is unclear. Jin et al. suggested polyclonal vascular lesion that can occur due to vascular proliferation after a vascular insult or...
Results
Thirteen patients (males= 7, females= 6) with a mean age 48.85±17.71 years. Comorbid malignant conditions included: Hepatocellular cancer (n= 1), Hodgkin Lymphoma (n= 1), and Thyroid cancer (n=1). Nevertheless, no disease correlation was observed with these malignancies. Mild-moderate Splenomegaly was common (n=7), and the mean spleen size was 11.03± 1.93 cm.
USG showed heterogeneous hypoechoic lesions(n= 11), hyperechoic lesions (n= 1), no vascularity (n= 6), internal vascularity (n= 2), peripheral vascularity (n= 2), and no calcifications (n= 9)(fig 1A, 2A & 2A).[Fig 1][Fig 2] SANT...
Conclusion
From our study results and review of the literature, we conclude that Splenic SANT is a benign neoplasm of the spleen that usually presents as a solitary mass with no reported case of recurrence after surgical resection.
The most consistent findings on the US: hypoechoic with internal vascularity, CT: Hypodense lesion with a progressive filling of the lesion through the arterial, venous, and delayed phase, MRI: T1WI: Iso-hyperintense, T2WI: Hypointense signals (The most reliable/consistent), DWI: Hypointense, Gd Contrast enhancement: Progressive centripetal enhancement, central non-enhancing focus...
Personal information and conflict of interest
A. Yousaf:
Nothing to disclose
H. M. Fazeel:
Nothing to disclose
S. S. Batool:
Nothing to disclose
A. L. F. Yasin:
Nothing to disclose
M. A. H. Shah:
Nothing to disclose
References
Martel M, Cheuk W, Lombardi L, Lifschitz MB, Chan JK, Rosai J. Sclerosing angiomatoid nodular transformation (SANT): report of 25cases of a distinctive benign splenic lesion. Am J Surg Pathol. 2004; 28:1268–1279.
Jin Y, Hu H, Regmi P, Li F, Cheng N. Treatment options for sclerosing angiomatoid nodular transformation of spleen. HPB (Oxford). 2020; 22(11):1577-1582. doi:10.1016/j.hpb.2020.01.014
Chang KC, Lee JC, Wang YC, Hung LY, Huang Y, Huang WT et al. Polyclonality in sclerosing angiomatoid nodular transformation ofthe spleen. Am J Surg Pathol.2016; 40:1343–1351.
Awamleh AA,...