A case of sclerosing angiomatoid nodular transformation of the spleen with increased accumulation of fluorodeoxyglucose after 5-year follow-up. (2017)

• Record Type: Journal Article
• Authors: Matsubara, Keiso; Oshita, Akihiko; Nishisaka, Takashi; Sasaki, Tamito; Matsugu, Yasuhiro; Nakahara, Hideki; Urushihara, Takashi; Itamoto, Toshiyuki
• Is Part Of: International journal of surgery case reports. Volume 39(2017)
• Page Start: 9
• Page End: 13
• Publication Date: 2017
• Subjects: SANT sclerosing angiomatoid nodular transformation -- CT computed tomography -- FDG fluorodeoxyglucose -- PET/CT positron emission tomography/computed tomography -- FNA fine-needle aspiration -- MRI magnetic resonance imaging -- SUVmax maximum standardized uptake value; Sclerosing angiomatoid nodular transformation -- Fluorodeoxyglucose positron emission tomography/computed tomography; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.07.035
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Although sclerosing angiomatoid nodular transformation (SANT) of the spleen is a new entity defined as a benign pathologic lesion, it is very difficult for ruling out the malignancy in preoperative imaging studies. Even when accumulation of fluorodeoxyglucose increased slightly during the follow-up period and suggested the possibility of malignant diseases, it is necessary to make a diagnosis of splenic SANT comprehensively. Abstract: Introduction: Sclerosing angiomatoid nodular transformation (SANT) of spleen is a new entity defined as a benign pathologic lesion. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) shows weak accumulation, thereby ruling out the malignancy in preoperative diagnosis is difficult. Herein, we reported a case of shrinking SANT with increased FDG accumulation during a 5-year follow-up period, which was treated by laparoscopic splenectomy. Presentation of case: A 64-year-old female had been referred to our hospital for the evaluation of a splenic tumor. Initial contrast-enhanced computed tomography (CT) showed a well-defined, and ovoid hypoattenuating lesion, measuring 52 mm in diameter in the spleen. Initial PET/CT revealed accumulation of FDG in the tumor (maximum standardized uptake value [SUVmax]: 2.8). The mass was diagnosed as SANT, and the patient was followed-up every 6–12 months for 5 years. Follow-up PET/CT revealed increased accumulation of FDG (SUVmax: 3.5). As it was suspicious considering the differential diagnosis, including malignant lymphoma and inflammatory pseudotumor, she underwent laparoscopic splenectomy. The pathological results showed three types of vessels including capillaries, ectatic small veins, and sinusoids-like vessels, consistent with the features of SANT. Discussion: A SANT may have features that resemble those of malignancy, including the growing mass and the increase of FDG accumulation. Conclusion: Although the preoperative diagnosis of SANT is difficult, it is necessary to make a diagnosis of SANT comprehensively, even when accumulation of FDG increased slightly during the follow-up period and suggested the possibility of malignant diseases.