Head & neck · 2025
"Tension Chyle Leak": A Life-Threatening Sequela of Thoracic Duct Injury Following Resection of BRAF-Mutated Anaplastic Thyroid Carcinoma.
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Botros Karim, Esfahani Khashayar, Sultanem Khalil, Spicer Jonathan D, Mlynarek Alex A, Hier Michael P, Mascarella Marco A
Аннотация
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 BRAFV600E-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.
METHODS: A 55-year-old man presented with a rapidly enlarging neck mass. Work-up was consistent with metastatic unresectable BRAFV600E-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.