Sclerosing angiomatoid nodular transformation of the spleen

Case contributed by Dalia Ibrahim
Diagnosis certain

Presentation

Incidentally discovered splenic focal lesion on ultrasound.

Patient Data

Age: 40 years
Gender: Female

The spleen shows a fairly defined mass lesion at its middle pole. It show mild early heterogeneous contrast enhancement (close to the splenic parenchymal enhancement) with progressive enhancement on portal venous showing hypodense hypovascular center, and further progressive contrast enhancement on delayed imaging with fill in of the central hypodense area.

Diagnostic possibilities included sclerosing angiomatoid transformation of the spleen, hemangioma or hamartoma, however the hypovascular center of the lesion on the portal phase which showed progressive fill in of contrast at the delayed series made sclerosing angiomatoid transformation of the spleen the main possibility here.

Mild increased FDG uptake by he splenic focal lesion (similar to/slightly higher than the adjacent splenic parenchymal metabolic activity).

The splenic focal lesion elicits low signal on T2 WI with hyperintense center with facilitated diffusion.

Case Discussion

The patient underwent splenectomy. Histopathology showed lesion consisting of fibrous tissue with variable-sized vascular nodules, scattered plasma cells and lymphocytes, the vascular components were composed of variably sized blood vessels with endothelial linning. Nuclear atypia was absent. No malignancy.

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a recently described, rare, benign vascular lesion.

SANT has a typical radiological pattern. Multiphasic CT shows hypovascular center with an enhancing rim and radiating vascularized tissue penetrating from the periphery toward the center of the lesion. Progressive central enhancement with delayed imaging thought to be the result of contrast penetrating the center of the lesion from the vascular rim "spoke wheel" pattern

On MRI: it typically elicits low signal on T2 WI in contrast to most of the other splenic focal lesions.

On DWI: it shows facilitated diffusion, in contrast to neoplastic focal lesions.

On PET-CT: most cases don't show increased FDG uptake, yet some authors reported mild to moderate increased FDG uptake.

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