Published online Aug 27, 2021. doi: 10.4240/wjgs.v13.i8.848
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
Processing time: 128 Days and 11.5 Hours
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.
To evaluate the incidence of SANT among splenic tumors and the decision-making process of SANT management.
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.
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.
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.