"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.

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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.