Synchronous HPV-related Tonsillar Squamous Cell Carcinoma and Type AB Thymoma: Successful Cancer Treatment Complicated by Fatal COVID-19 Infection.

Abstract

Background/aim: Patients with synchronous tonsillar squamous cell carcinoma (SCC) and mediastinal thymoma are exceedingly rare. We present this case to highlight the diagnostic challenges and complex treatment decisions required when managing dual primary malignancies.

Case report: A 63-year-old man presented with a 4-week history of throat discomfort. Initial examination revealed a right tonsillar mass, a mediastinal mass, and mild elevation of the left hemidiaphragm. A biopsy of the tonsil demonstrated p16-positive SCC, and a computed tomography (CT)-guided needle biopsy of the mediastinal mass revealed a thymoma, type AB. Following a multidisciplinary tumor board discussion, the patient underwent definitive external beam radiotherapy to the oropharynx [66 gray (Gy) in 33 fractions over 50 days] with concurrent high-dose cisplatin chemotherapy. Despite supportive measures, coronavirus disease (COVID-19) pneumonia occurred one-month post-radiotherapy, exacerbating his respiratory compromise. Six months later, he received a robotic-assisted thymectomy and lung wedge resection for the thymoma, during which the involved phrenic nerve was meticulously preserved. Histopathology confirmed malignant thymoma without metastasis. The patient recovered very well. However, recurrent COVID-19 infection and multifocal pneumonia two months post-surgery deteriorated his respiratory status, leading to home hospice care.

Conclusion: To the best of our knowledge, this is the first documented case with synchronous tonsillar SCC and mediastinal thymoma. This case underscores the complexity of treating synchronous malignancies and illustrates how multidisciplinary collaboration is pivotal for optimal outcomes, particularly when managing evolving complications and balancing aggressive therapies against overall patient well-being.