Implications of COVID-19 On A Rapidly Growing Thymoma Case

Thymomas are a rare form of malignancy that most commonly present as an anterior mediastinal mass. These slow-growing neoplasms originate from thymic epithelial cells. Although most are asymptomatic, they can have a variety of presentations. Local compressive symptoms include shortness of breath, chest pain, cough, dyspnea, or orthopnea. Paraneoplastic syndromes, such as myasthenia gravis or pure red cell aplasia are seen in patients with thymomas due to abnormal T-cell maturation in the thymus, leading to an increased risk of autoimmune conditions. We report a case of a 71-year-old male with multiple comorbid conditions presenting to the emergency room after a mechanical fall that incidentally was found to have a 3.8 cm x 6.0 cm anterior mediastinal mass on chest computed tomography (CT). The patient did not initially present with any local compressive symptoms or paraneoplastic syndromes. Due to the Coronavirus disease-19 (COVID-19) pandemic, the patient did not follow through with his discharge recommendations for a surgical consultation. Over a year later, the patient presented to the hospital with chest pain, and repeat chest CT revealed that the mass had increased in size to 8.2 cm x 7.7 cm. A multidisciplinary approach was used to determine the patient's course of treatment. The patient then underwent median sternotomy, radical thymectomy, and mediastinal lymph node dissection. Following surgery, the patient became hypotensive and bradycardic during dialysis, despite surgical optimization and coordination with a multidisciplinary team. Ultimately the patient passed away from a cardiac arrest. It is imperative we consider the negative impacts that COVID-19 pandemic has had on this patient. The delay in treatment allowed the thymoma to multiply in size, resulting in a more extensive surgery. This in turn led to unforeseen complications which resulted in the untimely death of the patient.