Neck masses can be a challenge because several cancers metastasize in this area. Head and neck tumors are more commonly responsible of lymph nodes in neck. However, also gastric cancer can be metastatic in this area. We present a rare case of neck gastric meta with negative Virchow's lymph node.

Objective: Surgical/anesthetic management of patients undergoing surgical tracheostomy for Covid-19 pneumonia aiming at minimizing the risk of health care workers (HCWs) infection. Design, Setting and Paticipants: Twenty-three Caucasian patients, mean age 67 years, with long-term orotracheal intubation for severe acute respiratory syndrome Covid-19 pneumonia were submitted to surgical tracheostomy, between February 3rd and March 22nd 2020, according to our specific procedure. Main outcomes and Measures: Air exposure time (AET) and frequency of infection in HCWs. Results: No complication, in terms of bleeding or tracheostomy cannula displacement, was observed. No HCWs involved in the procedures contracted Covid-19. Conclusions: The tracheostomy technique we describe minimizes the risk of surgeon’s exposure to patient’s aerosol drops/expired air and the possibility of HCWs infection during the procedure carried out in patients with Covid-19 pneumonia. The details and advantages of our approach with respect to “standard” tracheotomy and percutaneous procedures are discussed.