title: Hand-assisted laparoscopic splenectomy for sclerosing angiomatoid nodular transformation of the spleen complicated by chronic disseminated intravascular coagulation: a case report.
abstract: A 36-year-old man who presented with a nosebleed and anemia was referred to our hospital. Laboratory test results showed platelet depletion, decreased levels of fibrinogen, and increased fibrinogen degeneration products. CT showed a 13-cm splenic tumor. T2 -weighted MRI revealed a high-intensity mass. We preoperatively diagnosed splenic hemangioma with chronic disseminated intravascular coagulation and scheduled an operation to relieve the disseminated intravascular coagulation. We also performed hand-assisted laparoscopic splenectomy to ensure easy handling of the splenomegaly. The resected specimen microscopically consisted of hemorrhages and hemangiomatous lesions, and multiple angiomatoid nodules were scattered and separated by fibrocollagenous stroma with inflammatory cells. Three types of vessels (capillaries, sinusoids and small veins) were contained in the angiomatoid nodules, and the pathological diagnosis was sclerosing angiomatoid nodular transformation. The results of this case suggest that we should consider sclerosing angiomatoid nodular transformation in the differential diagnosis of patients with splenic tumors, as sclerosing angiomatoid nodular transformation with hemangiomatous features may cause coagulation disorders for which splenectomy should be performed.
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kakisaka
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kamiyama
authors.forename: Hideki
authors.initials: H
authors.lastname: Yokoo
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Orimo
authors.forename: Kenji
authors.initials: K
authors.lastname: Wakayama
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Tsuruga
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kamachi
authors.forename: Taisuke
authors.initials: T
authors.lastname: Harada
authors.forename: Fumi
authors.initials: F
authors.lastname: Kato
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Yamada
authors.forename: Tomoko
authors.initials: T
authors.lastname: Mitsuhashi
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000601:surgery; D058733:Hand-Assisted Laparoscopy; D018219:Histiocytoma, Benign Fibrous / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D013156:Splenectomy / Q000379:methods*; D013160:Splenic Neoplasms / Q000150:complications / Q000601:surgery*
keywords: Disseminated intravascular coagulation; laparoscopic splenectomy; sclerosing angiomatoid nodular transformation