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Título

Steps of mesenteric glomic tumor laparoscopic resection, postponed surgery due to Sars-CoV-2 pandemic

Resumo

INTRODUCTION
Mesenteric tumors (MT) are rare and include a diverse group of histological entities with different treatments and prognosis. Glomic tumors, on the other hand, are classically described in limb ends; mesenteric occurrence is exceptional1. They are rarely reported and consist of mesenchymal cells similar to modified smooth muscle cells of normal glomic bodies and glomic arteriovenous anastomosis, highly specialized in blood flow regulation for thermal homeostasis2,3.
We show on video the steps of a laparoscopic resection of this lesion, which appeared less than 5 times in the medical literature of the last 50 years.

PRESENTATION
A 78 year-old male, presenting with mild chronic pain in the right hemiabdomen, diagnosed by computed tomography with a hypervascular mass of 60 x 48 x 40 mm, in the mesenteric fat anterior and inferior to the right kidney. Surgery was indicated, and postponed for 10 months due to Sars-CoV-2 pandemic. He underwent uneventful laparoscopic resection, which steps are shown in this video. The diagnosis of glomic tumor was surprisingly confirmed by immunohistochemical profile.

DISCUSSION
MT are rare and are usually diagnosed based on radiological findings and vague abdominal symptoms1. A glomic tumor in this location is even rarer, and may present with a large abdominal volume, an infiltrative pattern, necrosis, nuclear atypia and mitotic activity1,2. In this case, the malignancy potential is low (KI 67 = 2%).
The treatment of choice is surgery; recurrences are rare and, if they occur, they indicate an infiltrating tumor or that resection was inadequate3. In cases of malignancy, delayed surgery is catastrophic in terms of prognosis. The postponement of cancer surgeries in the last year occurred in all countries due to the overload on the health system caused by the pandemic. Fortunately in this case there were no complications or disease progression during this period, and total resection was achieved with free surgical margins.

FINAL COMMENTS
The pandemic caused by the new Coronavirus COVID-19 dissemination caused a delay in oncological diagnosis and treatment worldwide. Prioritization for elective surgeries had to be individualized. We emphasize the importance of elective surgeries and the occurrence of very rare cases in this context. As glomic tumors are a rare differential diagnosis of solid tumors of abdominal soft tissues, we describe the steps of laparoscopic resection in mesenteric topography.

Palavras-chave

glomic tumors; mesentery; mesenchymal neoplasm