Tseng Hao, Ho Cheng-Maw, Tien Yu-Wen
School of Medicine, National Taiwan University College of Medicine, Taipei 100, Taiwan.
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan.
World J Gastrointest Surg. 2021 Aug 27;13(8):848-858. doi: 10.4240/wjgs.v13.i8.848.
Many clinicians and surgeons are unfamiliar with the sclerosing angiomatoid nodular transformation (SANT), which is gaining recognition as a benign splenic tumor. We challenge that SANT is rare and whether surgical intervention could be avoided through critical imaging review.
To evaluate the incidence of SANT among splenic tumors and the decision-making process of SANT management.
Twenty hospitalized patients who underwent splenectomy in 2018 and 2019 in a tertiary university hospital were retrospectively reviewed, and their data on imaging, diagnosis, surgical indications, and courses were recorded. All pathology results were confirmed by pathologist. Discriminative features differentiating SANT from other non-SANT splenic tumors were descriptively analyzed in this case series.
Fourteen out of 20 patients who underwent splenectomy had splenic tumors, including 3 SANTs (21% splenic tumors), 6 non-SANT benign lesions (43%), 2 metastatic tumors, and 3 lymphomas. Hypointensity on T2-weighted magnetic resonance imaging (MRI), spoke wheel enhancing pattern in contrasted computed tomography or MRI, and cold spot (low fluorodeoxyglucose uptake) in positron emission tomography (PET) scan helped establish the diagnosis of SANT. Lymphoma, presenting with a hot spot on the PET scan were differentiated from SANT. Surgical indications were reformatted for splenic tumors. Splenectomy need not be performed in patients with typical imaging features of SANT.
SANT is not a rare disease entity in clinical practice. Splenectomy should not be routinely indicated as the only management option for SANT with typical imaging features.
许多临床医生和外科医生并不熟悉硬化性血管瘤样结节性转化（SANT），这是一种逐渐得到认可的脾脏良性肿瘤。我们质疑SANT是否罕见，以及通过严格的影像学评估是否可以避免手术干预。
评估SANT在脾脏肿瘤中的发病率以及SANT治疗的决策过程。
回顾性分析2018年和2019年在一所三级大学医院接受脾切除术的20例住院患者，记录他们的影像学、诊断、手术指征及病程数据。所有病理结果均经病理学家确认。在本病例系列中，对区分SANT与其他非SANT脾脏肿瘤的鉴别特征进行了描述性分析。
20例行脾切除术的患者中有14例患有脾脏肿瘤，其中3例为SANT（占脾脏肿瘤的21%），6例为非SANT良性病变（43%），2例为转移性肿瘤，3例为淋巴瘤。T2加权磁共振成像（MRI）上的低信号、对比增强计算机断层扫描或MRI上的辐条轮状强化模式以及正电子发射断层扫描（PET）中的冷区（低氟脱氧葡萄糖摄取）有助于SANT的诊断。PET扫描显示为热点的淋巴瘤与SANT相鉴别。针对脾脏肿瘤重新制定了手术指征。具有SANT典型影像学特征的患者无需进行脾切除术。
在临床实践中，SANT并非罕见疾病。对于具有典型影像学特征的SANT，不应常规将脾切除术作为唯一的治疗选择。
