Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2021; 13(8): 848-858
Published online Aug 27, 2021. doi: 10.4240/wjgs.v13.i8.848
Reappraisal of surgical decision-making in patients with splenic sclerosing angiomatoid nodular transformation: Case series and literature review
Hao Tseng, Cheng-Maw Ho, Yu-Wen Tien
Hao Tseng, School of Medicine, National Taiwan University College of Medicine, Taipei 100, Taiwan
Hao Tseng, Department of Medical Education, and Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
Cheng-Maw Ho, Yu-Wen Tien, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
Author contributions: Tseng H drafted the manuscript; Tseng H and Ho CM designed the study; Tseng H conducted data processing; Tseng H, Ho CM and Tien YW performed data analysis; Ho CM and Tien YW were the directors responsible for general organization and instruction; all authors have read and agreed to the published version of the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of the National Taiwan University Hospital, Taipei, Taiwan (NTUH REC: 202102011RIND).
Informed consent statement: Because this was a retrospective study using chart review, the institutional review board waived the need for informed consent.
Conflict-of-interest statement: Tseng H, Ho CM and Tien YW all declare no conflict of interest.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Cheng-Maw Ho, MD, PhD, Associate Professor, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei 100, Taiwan.
Received: April 13, 2021
Peer-review started: April 13, 2021
First decision: June 23, 2021
Revised: June 28, 2021
Accepted: July 19, 2021
Article in press: July 19, 2021
Published online: August 27, 2021

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.

Keywords: Splenic tumor, Diagnosis, Surgical decision-making, Sclerosing angiomatoid nodular transformation, Retrospective study

Core Tip: Sclerosing angiomatoid nodular transformation (SANT) used to be considered a rare but benign lesion since it was recognized. However, SANT comprised one fifth patients who received splenectomy for splenic tumors in our university hospital cohort. The unique diagnostic image features of SANT include spoke wheel enhancing pattern in contrasted computed tomography or magnetic resonance imaging (MRI) and hypo-intensity on T2-weighted images of MRI. Clinicians should recognize this disease entity to avoid unnecessary overtreatment.