“Tension Chyle Leak”: A Life-Threatening Sequela of Thoracic Duct Injury Following Resection of BRAF-Mutated Anaplastic Thyroid Carcinoma

IF 2.3 3区医学 Q1 OTORHINOLARYNGOLOGY

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck Pub Date : 2025-01-28 DOI:10.1002/hed.28091

Karim Botros, Khashayar Esfahani, Khalil Sultanem, Jonathan D. Spicer, Alex A. Mlynarek, Michael P. Hier, Marco A. Mascarella

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Abstract

Background

Airway obstruction secondary to chyle leak is an exceptionally rare phenomenon. Here, we describe this complication in a patient with anaplastic thyroid carcinoma (ATC) undergoing consolidative surgery after BRAF-targeted therapy.

Methods

A 55-year-old man presented with a rapidly enlarging neck mass. Work-up was consistent with metastatic unresectable BRAF^V600E-mutant ATC. After a remarkable response to neoadjuvant dabrafenib and trametinib, he underwent curative-intent surgery with a right hemithyroidectomy and bilateral neck dissection. Within 48 h, he developed an expanding left neck mass with laryngeal obstruction due to a chyle leak.

Results

Despite surgical repair and maximal medical therapy, the leak persisted necessitating thoracoscopic ligation of the thoracic duct. Final pathology showed a completely excised residual tumor. The patient remains disease-free on long-term dabrafenib and trametinib.

Conclusions

BRAF-directed therapy has transformed the care of patients with mutated ATC. As more patients undergo consolidative surgery, increased vigilance is paramount in minimizing complications and their associated morbidity.

Abstract Image

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“紧张性乳糜漏”：braf突变的间变性甲状腺癌切除术后胸导管损伤的一个危及生命的后遗症。

背景：继发于乳糜漏的气道阻塞是一种非常罕见的现象。在这里，我们描述了一例间变性甲状腺癌（ATC）患者在braf靶向治疗后接受巩固手术的并发症。方法：55岁男性，颈部肿块迅速增大。检查结果与转移性不可切除的brafv600e突变ATC一致。在对新辅助治疗达非尼和曲美替尼有显著反应后，他接受了治疗目的手术，包括右甲状腺切除术和双侧颈部清扫。在48小时内，他出现了一个扩大的左颈部肿块，并由于乳糜漏导致喉梗阻。结果：尽管手术修复和最大限度的药物治疗，泄漏仍然存在，需要在胸腔镜下结扎胸导管。最终病理显示一个完全切除的残余肿瘤。患者长期服用达非尼和曲美替尼仍无疾病。结论：braf定向治疗已经改变了ATC突变患者的护理。随着越来越多的患者接受巩固手术，提高警惕对于减少并发症及其相关发病率至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck 医学-耳鼻喉科学

CiteScore

7.00

自引率

6.90%

发文量

278

审稿时长

1.6 months

期刊介绍： Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.