Sclerosing angiomatoid nodular transformation presenting with abdominal hemorrhage: First report in infancy

Abstract

A limited number of sclerosing Angiomatoid Nodular Transformation (SANT) have been reported in pediatric age. We describe the first case of SANT occurring in a nine-week-old female infant that was admitted to our unit for severe abdominal distension and rectal bleeding. Enlarged spleen was detected on physical examination. Laboratory investigations revealed severe anemia and coagulation abnormalities. Abdominal ultrasound and computed tomography revealed ascites and splenomegaly with a large mass at the lower medial splenic pole. A diagnosis of intraabdominal hemorrhage was presumed and an exploratory laparotomy was performed. A complete transformation of the giant splenomegaly to bossellated masses and multiple bleeding capsular ruptures without subcapsular hematoma were found and an urgent splenectomy was performed. At histology, a SANT was diagnosed (CD34, CD31, CD8 positivity). The postoperative follow up was uneventful. SANT may also occur in infancy with a potentially lifethreatening presentation. Splenectomy may represent the only treatment in severe cases.

Keywords: Sclerosing Angiomatoid Nodular Transformation; infant; spleen.

Figure 1.

Clinical and imaging features. A) severe abdominal distension at admission; B) large isodense splenic mass and abdominal hemorrhage at computed tomography.

Figure 2.

Histological evaluation. A-B) H&E - typical vascular appearance of SANT (x20, Panel A; and x40, Panel B); C-D) Diffuse positivity of vascular channels for CD 31 (x40, Panel C) and CD34 (x40, Panel D); E-F) Vascular channels positive for CD8 (x40, Panel E) and sclerosis (x40, Panel F)