Sclerosing angiomatoid nodular transformation of the spleen presenting with declining hematocrit: a case report and review of the literature

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is an extremely rare benign lesion originating from the splenic red pulp. The pathophysiologic mechanism has not yet been explained thoroughly. These tumors are mostly asymptomatic but cause nonspecific abdominal symptoms. Most SANTs are discovered incidentally on radiographic examination during workup for another disease or during surgery for an unrelated condition. We present a case of a 53-year-old female, whose anemia workup revealed a splenic mass. Progressive enlargement led to the decision of surgical removal. Pathology report of the spleen revealed the rare diagnosis of SANT. After removal, the patient's anemia gradually improved and on follow-up has completely recovered. Due to the risk of malignancy, surgical removal of the spleen is the preferred management. Careful preoperative planning is important to avoid unexpected hemorrhage during the operation. Depending on the size, open surgery should be preferred over laparoscopic.