Sclerosing Angiomatoid Nodular Transformation: A Series of Four Cases

Among the primary non haematopoietic neoplasms of the spleen, vascular neoplasms are the most common. These vascular neoplasms consist of haemangiomas, littoral cell angiomas, lymphangiomas, Splenic Hamartomas (SHs), haemangioendotheliomas, angiosarcomas and Sclerosing Angiomatoid Nodular Transformation (SANT). SANT is a recently described, rare non neoplastic vascular entity of the spleen. The majority of patients are asymptomatic and are incidentally picked up on Computed Tomography (CT) or Magnetic Resonance Imaging (MRI), but the diagnosis can mimic malignant lesions of the spleen on imaging studies. SANT is considered a female-predominant disease with a wide age distribution. Majority of cases have been reported in the adult age group, in paediatric age it is very rare. Hereby, the authors present a case series of four patients diagnosed with SANT in tertiary care hospital. Two of them were in the paediatric age group (four-year-old boy and 14-year-old girl), while the other two were middle-aged adults (46-year-old female and 41-year-old male). Both paediatric patients presented with symptoms of abdominal pain and discomfort and underwent an Ultrasonographic (USG) examination, which showed a well-circumscribed hypoechoic mass. Laboratory findings showed increased Erythrocyte Sedimentation Rate (ESR) and anaemia. Based on the clinical and radiological findings, diagnosis of splenic hamartoma and inflammatory pseudotumour were made in these cases. Unlike the paediatric patients, both adult patients were asymptomatic and diagnosed incidentally during routine radiological examinations. The USG examination showed a wellcircumscribed hypoechoic mass, with a difference in the size of the lesions. Light microscopic examination and immunohistochemical staining confirmed the diagnosis of SANT in all cases. The patients were followed for six months, during which no recurrences occurred. Although SANT is a benign tumour, it can sometimes be misdiagnosed by radiological studies, so surgical removal followed by histopathological and immunohistochemical examinations is required for an accurate diagnosis..