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. 2012;3(10):492-500.
doi: 10.1016/j.ijscr.2012.06.003. Epub 2012 Jul 7.

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

Gavin A Falk  1 , Nishank P Nooli, Gareth Morris-Stiff, Thomas P Plesec, Steven Rosenblatt
Affiliations

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

Gavin A Falk et al. Int J Surg Case Rep. 2012.

Abstract

Introduction: Sclerosing Angiomatoid Nodular Transformation of the spleen (SANT) is a rare benign vascular lesion of the spleen with extensive sclerosis and unknown etiology.

Presentation of case: 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.

Discussion: 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.

Conclusion: 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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Figures

Fig. 1
Fig. 1
Computed tomography (CT) scan showing the splenic lesion at the medial aspect of the lower spleen.
Fig. 2
Fig. 2
Magnetic resonance imaging (MRI) showing the lesion in the lower spleen.
Fig. 3
Fig. 3
The splenic parenchyma is replaced by innumerable well-circumscribed angiomatoid nodules separated by a fibrosclerotic and inflammatory stroma. The nodules are composed of a variety of cell types including capillaries, sinusoid-like spaces, and mononuclear inflammatory cells. Red blood cells are abundant.
Fig. 4
Fig. 4
CD31 immunostain highlights the abundant vascular structures (capillaries, sinusoid-like spaces, and veins) along with numerous single cells within the nodules, generating a complex network of CD31 immunoreactive cells.
Fig. 5
Fig. 5
CD34 immunostain highlights the capillaries, but not sinusoid-like spaces or any single cells.
Fig. 6
Fig. 6
CD8 immunostain highlights occasional sinusoid-like spaces (lower right) and scattered inflammatory cells, but is absent in other vascular structures (capillaries and veins).
Fig. 7
Fig. 7
CD68 immunostain highlights scattered single cells (presumably histiocytes) but no vessel-lining cells.
See this image and copyright information in PMC

References

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