Sclerosing angiomatoid nodular transformation of spleen (SANT) – case report and literature review

Abstract

Introduction Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular lesion of spleen of unknown aetiology. Case history A 74-year-old female presented with a 6 month history of iron deficiency anaemia and raised C-reactive protein. A full body CT scan showed an exophytic mass involving the anterior pole of the spleen measuring up to 6 cm in maximum dimension. No other abnormalities or relevant past history was noted. The clinical differential diagnoses were lymphoma or metastatic tumour, and thus a splenectomy was performed. Macroscopically, the spleen showed a well-demarcated tumour with red-brown nodules and central speckled area of fibrosis. The histology revealed a lesion composed of complex slit- like vascular spaces interspersed with spindle to ovoid cells and numerous inflammatory cells. On immunohistochemistry, all the nodules expressed CD31, CD34, SMA and CD30. EBER and IgG4 stains were negative. The lesion was finally diagnosed as a SANT. Discussion SANT is thought to be a reactive process rather than a true neoplasm. They may represent the final common pathway of a variety of splenic lesions including inflammatory pseudotumours. SANT may be related to IgG4 disease or EBV virus. They show upregulation of CD30 with respect to normal spleen. Splenectomy is usually the standard curative treatment.