A Case of Multifocal Sclerosing Angiomatoid Nodular Transformation (SANT) of the Spleen: A Case Report and Literature Review.

Sclerosing angiomatoid nodular transformation (SANT) is a rare, benign vascular lesion of the spleen that usually presents as a solitary mass. Multifocal SANT is extremely uncommon. We describe a 37-year-old man who was incidentally found to have multiple splenic lesions during a routine health checkup. Contrast-enhanced computed tomography revealed three solid masses, raising concern for primary splenic lymphoma. Laparoscopic splenectomy was performed, and intraoperative frozen section suggested SANT. Histopathological analysis confirmed the diagnosis, showing three distinct vascular components without malignant features. Although most reported cases of SANT present with a solitary mass, this case highlights a rare multifocal pattern. The lack of a characteristic imaging finding, the spoke-wheel pattern, and the rather small number of reported cases of multiple SANTs made it difficult to differentiate them from malignant tumors. Multifocal SANT is exceedingly rare and may mimic malignant splenic tumors, complicating preoperative diagnosis. This case underscores the need to include SANT in the differential diagnosis of splenic masses and suggests that partial splenectomy combined with intraoperative frozen section analysis may offer a less invasive management option. Broader recognition of multifocal SANT could help refine diagnostic algorithms and surgical strategies for splenic tumors.