Table of Contents
Definition / general | Epidemiology | Pathophysiology | Clinical features | Radiology description | Radiology images | Prognostic factors | Case reports | Treatment | Clinical images | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Electron microscopy description | Differential diagnosisCite this page: Shankar V. Sclerosing angiomatoid nodular transformation. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/spleensclerosingangiomatoid.html. Accessed January 28th, 2023.
Definition / general
- Sclerosing angiomatoid nodular transformation (SANT): rare benign lesion of spleen with unknown etiology (Arch Pathol Lab Med 2013;137:1309)
- Also called multinodular hemangioma
Epidemiology
- 2/3 women, mean age 48 years, range 30 - 60 years
Pathophysiology
- Probably reactive, not neoplastic
- May be splenic hamartomas which have undergone an unusual form of sclerosis, with a peculiar reactionary transformation of red pulp due to an exaggerated stromal response
Clinical features
- Presents as asymptomatic splenic mass, abdominal pain or splenomegaly
Radiology description
- Abdominal ultrasound, CT scans and MRI shows hypodense, sometimes multinodular splenic mass
- CT or MRI with contrast cannot distinguish SANT from the surrounding spleen parenchyma
Radiology images
Prognostic factors
- More aggressive if early age of onset
Case reports
- 11 year old boy with SANT and inflammatory pseudotumor-like areas (Indian J Pathol Microbiol 2011;54:829)
- 23 year old woman treated by laparoscopic partial splenectomy (Wideochir Inne Tech Malo Inwazyjne 2011;6:249)
- 23 year old woman treated with laparoscopic splenectomy (J Korean Surg Soc 2011;80:S59)
- 38 year old man with laparoscopic splenectomy (IJCRI 2012;3:34)
- 44 year old man with splenic mass (Case #364)
- 53 year old woman (Int J Surg Case Rep 2012;3:492)
- 65 year old man with SANT masquerading as sarcoma metastasis (Rare Tumors 2010;2:e45)
Treatment
- Splenectomy is standard treatment
- Indications for splenectomy included increase in mass size, marked splenomegaly or lingering suspicion of malignancy
Gross description
- Bosselated mass, solitary lesion, 3 - 17 cm, sharply demarcated from remaining spleen
- Composed of coalescing red-brown nodules in dense fibrous stroma
Gross images
Microscopic (histologic) description
- Micronodular appearance of slit-like, round or irregular shaped vascular spaces lined by plump endothelial cells with interspersed ovoid or spindle cells
- Smaller nodules surrounded by concentric collagen fibers
- Also numerous red blood cells
- Stroma contains myxoid to dense fibrous tissue with scattered myofibroblasts, inflammatory cells
- No / minimal atypia, no / rare mitotic figures, no necrosis
Microscopic (histologic) images
Case #364
Images hosted on other servers:
Positive stains
Electron microscopy description
- Small vascular spaces lined by endothelial cells with pinocytotic vesicles but no Weibel-Palade bodies
Differential diagnosis