Qiyang Shen, Shiyuan Wang, Jinfeng Zuo, Xingyu Liu, Fuping He, Chunlei Zhou, Sirui Pan, Nan Xie, Tao Li, Jianfeng Zhou
Pediatric splenic SANT should be considered in the differential diagnosis of a well-circumscribed solid splenic mass, even without the classic spoke-wheel sign. Because SANT is benign and splenectomy carries risks, a hypothesis-generating alternative is close observation after percutaneous core‑needle biopsy confirmation. However, this approach requires prospective validation; When imaging findings are atypical or malignancy cannot be excluded, surgical resection remains the definitive intervention, surgical resection remains the definitive intervention.
BACKGROUND: Sclerosing angiomatoid nodular transformation (SANT) is a benign non-neoplastic splenic lesion, well described in adults but rarely reported in children. Its clinical and imaging features in pediatric patients remain poorly characterized, and the optimal management-surgical versus non-operative-is uncertain, especially given the risks of splenectomy in children (e.g., overwhelming post‑splenectomy infection). This case series of four pediatric patients aims to describe the imaging-pathology correlation of SANT and generate a hypothesis regarding potential non-operative management in selected cases.
CASE DESCRIPTION: Four male children (age range 36-156 months) presented with solid splenic masses and underwent partial splenectomy. All four had preoperative ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Postoperative pathology confirmed isolated splenic SANT in three patients; one patient had synchronous splenic SANT and a separate pancreatic calcifying fibrous tumor. Imaging features varied: the characteristic "spoke‑wheel" enhancement pattern was present in only two of four cases. MRI better delineated fibrous septa, hemosiderin deposition, and nodular boundaries than CT. All patients recovered uneventfully after surgery. Follow‑up ranged from 52 to 132 months, with no recurrence or metastasis.
CONCLUSIONS: Pediatric splenic SANT should be considered in the differential diagnosis of a well-circumscribed solid splenic mass, even without the classic spoke-wheel sign. Because SANT is benign and splenectomy carries risks, a hypothesis-generating alternative is close observation after percutaneous core‑needle biopsy confirmation. However, this approach requires prospective validation; When imaging findings are atypical or malignancy cannot be excluded, surgical resection remains the definitive intervention, surgical resection remains the definitive intervention.