Sclerosing Angiomatoid Nodular Transformation (SANT) of the spleen: Case report and review of the literature

Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease Institute, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
International Journal of Surgery Case Reports 07/2012; 3(10):492-500. DOI: 10.1016/j.ijscr.2012.06.003
Source: PubMed


Sclerosing Angiomatoid Nodular Transformation of the spleen (SANT) is a rare benign vascular lesion of the spleen with extensive sclerosis and unknown etiology.
We report a new case of SANT of the spleen found in a 53-year-old female following detection of a splenic mass on a routine computed tomography (CT). The patient underwent an uncomplicated laparoscopic splenectomy and the specimen was sent for histopathologic examination.
A review of the 97 reported cases of SANT found in the literature was undertaken. There were 43 males and 54 females with a median age of 46 years (range: 11-82 years). SANT is classically considered to be a female predominant disease, however 44.3% of reported case were male and the gender predilection may soon be neutralized as more cases are reported. 65 of the 97 (67%) patients were in 30-60 year age group. The majority of lesions (n=50) were incidentally found on imaging, and for those patients presenting with symptoms, abdominal pain (n=18) was the predominant symptom.
The diagnosis of SANT should be considered in any patient presenting with a splenic lesion that contains an angiomatoid or inflammatory component. As the differential diagnosis for SANT includes malignant pathologies, and currently no reliable diagnostic radiological feature has been identified to differentiate between these conditions, SANT will continue to be diagnosed on the basis of surgical histopathology.

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    • "SANT is composed of multiple angiomatoid nodules derived from the brown-red pulp separated by interspersed bands of fibrous tissue which unite to form a central stellate fibrous scar. The size of these tumors is reported to range between 3 and 17 cm, and the male-to-female ratio is approximately 1:1 [1] [3]. Microscopically, SANT has numerous capillaries and sinusoidal spaces separated by a fibrous stroma. "
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    ABSTRACT: Sclerosing angiomatoid nodular transformation (SANT) is a recently recognized and rare, non-neoplastic lesion of the spleen. It has a distinct gross appearance. Some papers have reported an increased SANT diameter during the follow-up period. This makes the diagnosis between benign and malignant difficult. We present 2 cases of SANT whose size increased during the follow-up period. Diffusion weighted MR 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 for diagnosing SANT preoperatively.
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