Well-Differentiated Thyroid Carcinoma Presenting with Sternal Invasion: Complex Resection and Reconstruction in the COVID-19 Era

Background: Advanced thyroid malignancies may invade adjacent structures creating challenging approaches to surgical resection. Methods: We report a 48-year-old gentleman who was found to have a papillary thyroid cancer with invasion of the sternum. Results: The patient presented with pain and swelling in the upper chest. Computed tomography (CT) scanning demonstrated a paratracheal mass with invasion of the manubrium. Core needle biopsy demonstrated papillary thyroid cancer. Surgery was performed during the COVID-19 pandemic. En bloc total thyroidectomy with resection of the manubrium was performed. The defect was closed using a biological mesh, covered with a pectoralis major flap. Final pathology demonstrated a completely excised T4N1bM1 well-differentiated papillary thyroid carcinoma. The patient made an uneventful recovery. Conclusion: En bloc total thyroidectomy with sternal resection can be performed safely with low morbidity. Reconstruction of the sternal defect can be performed with biological mesh and pedicled muscle flap to reduce infection risk.