Polyclonality in sclerosing angiomatoid nodular transformation of the spleen

Kung Chao Chang, Jen Chieh Lee, Yu Chu Wang, Liang Yi Hung, Yenlin Huang, Wan Ting Huang, Ren Ching Wang, Tse Ching Chen, Yi Shan Tsai, L. Jeffrey Medeiros

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a morphologically distinctive lesion. Although the clinical course of SANT is benign, its reactive or neoplastic nature remains to be clarified. Furthermore, some investigators have suggested that SANT is related to IgG4 sclerosing lesion or inflammatory pseudotumor with stromal cells positive for Epstein-Barr virus (EBV). In this study, we assessed 22 cases of SANT derived from adult women. Clinical data and follow-up information were obtained by chart review. Immunohistochemical studies for IgG4, IgG, and CD21 stains and in situ hybridization to detect EBV-encoded small RNAs were performed. We also assessed genomic DNA extracted from paraffin-embedded tissue for human androgen-receptor α gene analysis using conventional and methylation-specific polymerase chain reaction methods. The median patient age was 41.5 years (range, 25 to 82 y). Most (77%) patients presented with a single mass that was detected incidentally (59%). The mean size of the lesions was 3.8 cm (range, 1.0 to 9.0 cm). Clinical symptoms correlated with multiple lesions (P=0.043) but not lesional size (P=0.637) or location in the spleen (hilum vs. periphery, P=0.696). None of the cases had evidence of IgG4-related disease or recurred after splenectomy. The mean number of IgG4+ cells was 27.7 (range, 4 to 125), and the mean IgG4/IgG ratio was 16.4% (range, 1.6% to 55.7%) with only 2 cases being >40%. Cases with higher IgG4+ cells did not correlate with inflammatory pseudotumor-like morphology. No lesions were positive for EBV-encoded small RNAs, and almost all cases with informative results (n=19) showed a polyclonal pattern. We conclude that SANT is a polyclonal, reactive lesion rather than a neoplasm.

Original languageEnglish
Pages (from-to)1343-1351
Number of pages9
JournalAmerican Journal of Surgical Pathology
Volume40
Issue number10
DOIs
Publication statusPublished - 2016 Jan 1

Fingerprint

Spleen
Immunoglobulin G
Human Herpesvirus 4
Plasma Cell Granuloma
RNA
Splenectomy
Stromal Cells
Paraffin
Methylation
In Situ Hybridization
Coloring Agents
Cell Count
Research Personnel
Polymerase Chain Reaction
DNA
Genes
Neoplasms

All Science Journal Classification (ASJC) codes

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

Chang, Kung Chao ; Lee, Jen Chieh ; Wang, Yu Chu ; Hung, Liang Yi ; Huang, Yenlin ; Huang, Wan Ting ; Wang, Ren Ching ; Chen, Tse Ching ; Tsai, Yi Shan ; Medeiros, L. Jeffrey. / Polyclonality in sclerosing angiomatoid nodular transformation of the spleen. In: American Journal of Surgical Pathology. 2016 ; Vol. 40, No. 10. pp. 1343-1351.
@article{8d7d6a9f3b6f4ff98f783ce325563603,
title = "Polyclonality in sclerosing angiomatoid nodular transformation of the spleen",
abstract = "Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a morphologically distinctive lesion. Although the clinical course of SANT is benign, its reactive or neoplastic nature remains to be clarified. Furthermore, some investigators have suggested that SANT is related to IgG4 sclerosing lesion or inflammatory pseudotumor with stromal cells positive for Epstein-Barr virus (EBV). In this study, we assessed 22 cases of SANT derived from adult women. Clinical data and follow-up information were obtained by chart review. Immunohistochemical studies for IgG4, IgG, and CD21 stains and in situ hybridization to detect EBV-encoded small RNAs were performed. We also assessed genomic DNA extracted from paraffin-embedded tissue for human androgen-receptor α gene analysis using conventional and methylation-specific polymerase chain reaction methods. The median patient age was 41.5 years (range, 25 to 82 y). Most (77{\%}) patients presented with a single mass that was detected incidentally (59{\%}). The mean size of the lesions was 3.8 cm (range, 1.0 to 9.0 cm). Clinical symptoms correlated with multiple lesions (P=0.043) but not lesional size (P=0.637) or location in the spleen (hilum vs. periphery, P=0.696). None of the cases had evidence of IgG4-related disease or recurred after splenectomy. The mean number of IgG4+ cells was 27.7 (range, 4 to 125), and the mean IgG4/IgG ratio was 16.4{\%} (range, 1.6{\%} to 55.7{\%}) with only 2 cases being >40{\%}. Cases with higher IgG4+ cells did not correlate with inflammatory pseudotumor-like morphology. No lesions were positive for EBV-encoded small RNAs, and almost all cases with informative results (n=19) showed a polyclonal pattern. We conclude that SANT is a polyclonal, reactive lesion rather than a neoplasm.",
author = "Chang, {Kung Chao} and Lee, {Jen Chieh} and Wang, {Yu Chu} and Hung, {Liang Yi} and Yenlin Huang and Huang, {Wan Ting} and Wang, {Ren Ching} and Chen, {Tse Ching} and Tsai, {Yi Shan} and Medeiros, {L. Jeffrey}",
year = "2016",
month = "1",
day = "1",
doi = "10.1097/PAS.0000000000000716",
language = "English",
volume = "40",
pages = "1343--1351",
journal = "American Journal of Surgical Pathology",
issn = "0147-5185",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

Polyclonality in sclerosing angiomatoid nodular transformation of the spleen. / Chang, Kung Chao; Lee, Jen Chieh; Wang, Yu Chu; Hung, Liang Yi; Huang, Yenlin; Huang, Wan Ting; Wang, Ren Ching; Chen, Tse Ching; Tsai, Yi Shan; Medeiros, L. Jeffrey.

In: American Journal of Surgical Pathology, Vol. 40, No. 10, 01.01.2016, p. 1343-1351.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Polyclonality in sclerosing angiomatoid nodular transformation of the spleen

AU - Chang, Kung Chao

AU - Lee, Jen Chieh

AU - Wang, Yu Chu

AU - Hung, Liang Yi

AU - Huang, Yenlin

AU - Huang, Wan Ting

AU - Wang, Ren Ching

AU - Chen, Tse Ching

AU - Tsai, Yi Shan

AU - Medeiros, L. Jeffrey

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a morphologically distinctive lesion. Although the clinical course of SANT is benign, its reactive or neoplastic nature remains to be clarified. Furthermore, some investigators have suggested that SANT is related to IgG4 sclerosing lesion or inflammatory pseudotumor with stromal cells positive for Epstein-Barr virus (EBV). In this study, we assessed 22 cases of SANT derived from adult women. Clinical data and follow-up information were obtained by chart review. Immunohistochemical studies for IgG4, IgG, and CD21 stains and in situ hybridization to detect EBV-encoded small RNAs were performed. We also assessed genomic DNA extracted from paraffin-embedded tissue for human androgen-receptor α gene analysis using conventional and methylation-specific polymerase chain reaction methods. The median patient age was 41.5 years (range, 25 to 82 y). Most (77%) patients presented with a single mass that was detected incidentally (59%). The mean size of the lesions was 3.8 cm (range, 1.0 to 9.0 cm). Clinical symptoms correlated with multiple lesions (P=0.043) but not lesional size (P=0.637) or location in the spleen (hilum vs. periphery, P=0.696). None of the cases had evidence of IgG4-related disease or recurred after splenectomy. The mean number of IgG4+ cells was 27.7 (range, 4 to 125), and the mean IgG4/IgG ratio was 16.4% (range, 1.6% to 55.7%) with only 2 cases being >40%. Cases with higher IgG4+ cells did not correlate with inflammatory pseudotumor-like morphology. No lesions were positive for EBV-encoded small RNAs, and almost all cases with informative results (n=19) showed a polyclonal pattern. We conclude that SANT is a polyclonal, reactive lesion rather than a neoplasm.

AB - Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a morphologically distinctive lesion. Although the clinical course of SANT is benign, its reactive or neoplastic nature remains to be clarified. Furthermore, some investigators have suggested that SANT is related to IgG4 sclerosing lesion or inflammatory pseudotumor with stromal cells positive for Epstein-Barr virus (EBV). In this study, we assessed 22 cases of SANT derived from adult women. Clinical data and follow-up information were obtained by chart review. Immunohistochemical studies for IgG4, IgG, and CD21 stains and in situ hybridization to detect EBV-encoded small RNAs were performed. We also assessed genomic DNA extracted from paraffin-embedded tissue for human androgen-receptor α gene analysis using conventional and methylation-specific polymerase chain reaction methods. The median patient age was 41.5 years (range, 25 to 82 y). Most (77%) patients presented with a single mass that was detected incidentally (59%). The mean size of the lesions was 3.8 cm (range, 1.0 to 9.0 cm). Clinical symptoms correlated with multiple lesions (P=0.043) but not lesional size (P=0.637) or location in the spleen (hilum vs. periphery, P=0.696). None of the cases had evidence of IgG4-related disease or recurred after splenectomy. The mean number of IgG4+ cells was 27.7 (range, 4 to 125), and the mean IgG4/IgG ratio was 16.4% (range, 1.6% to 55.7%) with only 2 cases being >40%. Cases with higher IgG4+ cells did not correlate with inflammatory pseudotumor-like morphology. No lesions were positive for EBV-encoded small RNAs, and almost all cases with informative results (n=19) showed a polyclonal pattern. We conclude that SANT is a polyclonal, reactive lesion rather than a neoplasm.

UR - http://www.scopus.com/inward/record.url?scp=84981713482&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84981713482&partnerID=8YFLogxK

U2 - 10.1097/PAS.0000000000000716

DO - 10.1097/PAS.0000000000000716

M3 - Article

C2 - 27526296

AN - SCOPUS:84981713482

VL - 40

SP - 1343

EP - 1351

JO - American Journal of Surgical Pathology

JF - American Journal of Surgical Pathology

SN - 0147-5185

IS - 10

ER -