An incidental finding of retroperitoneal paraganglioma during the coronavirus disease 2019 pandemic: a case report.

BACKGROUND: Extra-adrenal paraganglioma of the retroperitoneum is a very rare neoplasm arising from cells of the primitive neural crest. Although paragangliomas are considered benign and are often found incidentally, they have the potential to metastasize. CASE PRESENTATION: We report the case of a 68-year-old Caucasian woman with an incidental diagnosis of retroperitoneal paraganglioma that was discovered on chest computed tomography performed for high suspicion of coronavirus disease 2019 pneumonia. The patient showed no metastasis and was successfully treated by complete surgical removal of the tumor. CONCLUSION: As the diagnosis of paragangliomas is often delayed because of absent clinical symptoms, they represent a significant diagnostic challenge. Although surgery may exacerbate coronavirus disease 2019 infection, surgical resection of this tumor is prioritized, given its malignancy potential, and it must be performed as soon as no infection is detected.

Surgical oncology for non-COVID-19 patients during the pandemic

Introduction/Background*The COVID-19 pandemic has turned the standard of care of medicine worldwide into a “public health emergency of international concern. “Cancer patients are a unique population in that they are vulnerable to COVID-19, particularly if immunocompromised, and also, their oncologic outcome is based on the type and timing of the treatment.MethodologyA retrospective review comparing all surgical activities between the year before COVID-19 and the year after.This study was conducted in the Surgical Oncology Department in Salah Azaiez Institute of Oncology, the reference cancer care center in Tunisia.Result(s)*In our center, we created a new surgical procedures team.There was a significant reduction in the median daily breast surgery, superficial surgery, and ambulatory surgery (< 0,001). But not all operation types decreasing in frequency.Three months after COVID -19, we selected patients for laparotomy and decreased our activity by 50%.Starting from June 2020, we have increased our activity to exceed that of 2019. No increase in mortality or morbidity from treatment during COVID-19 for operated patients.The total surgically consults volume decreased by 36,17% in the post-COVID-19 period, significantly reducing the median daily consult volume (p<0.001).Conclusion*In this new context, the decision for surgery is driven not only by what is best for the individual patient but also by the concern for transmitting COVID-19 to patients and health care workers.

Uterine lipoleimyoma miming ovarian teratoma: A diagnosis challenge

Introduction Uterine lipoleimyoma (UL) is a rare benign tumor affecting especially perimenopausal and menopausal women and it is often diagnosed as a malignant tumor in radiology findings. Methods We report a case of a female patient aged 66 years treated for left parauterine mass in Salah Azaiz Institute of Oncology, Tunis, Tunisia in March 2020. Case Report A 66-year-old woman with medical history of diabetes, high blood pressure and coronary artery disease consulted for a pelvic mass fortuitously discovered on a CT scan. The physical exam was normal. The thoracic-abdominal pelvic scan showed a multi-partitioned well-defined left ovarian mass of fat density, measured 113 mm in its great diameter. Tumor markers CA 125, CA 19-9 and ACE were negative. The diagnosis of ovarian teratoma was suspected on radiological findings. We decided to perform an exploratory laparotomy, instead of laparoscopy due to COVID 19 outbreak. Intraoperatively, we found a uterine mass with fibroid appearance. The patient underwent total non-conservative hysterectomy. The frozen section concluded to the diagnosis of UL. The postoperative course was straightforward. The diagnosis of UL was confirmed by the final histologic examination. Conclusion The resemblance between UL and ovarian teratoma on the CT scan leads to confusion. Only surgical exploration and histologic examination allow to make the right diagnosis and then adjust a best management of this disease. (Figure Presented).