[Minimally invasive follicular thyroid carcinoma : Not always total thyroidectomy]. / Minimal-invasives follikuläres Schilddrüsenkarzinom : Eine Thyreoidektomie ist nicht obligat.

Current treatment guidelines for follicular thyroid carcinoma (FTC) recommend total thyroidectomy, lymphadenectomy and radioiodine ablation. Considering the low malignant potential of minimally invasive follicular thyroid carcinoma (MIFTC), a limited radical therapeutic procedure may be adequate. MIFTC is an intensely discussed group of tumors and a review of the literature reveals disagreement among experts concerning the criteria for a distinct definition. Therefore, in 2005 Rosai proposed a clinically more significant classification of FTC based on the extent of capsular and vascular invasion: MIFTC with capsular invasion only, with limited (< or =3) vascular invasion, encapsulated FTC with extensive (>3) vascular invasion and broadly invasive FTC with extensive invasive growth.For the diagnosis of MIFTC a complete investigation of the encapsulated follicular lesion should be performed by the pathologist and examination of at least 10 tissue blocks is mandatory. Due to the excellent prognosis hemithyroidectomy constitutes an adequate therapeutic approach in MIFTC with capsular invasion only and may also be considered for MIFTC with limited vascular invasion. There are no indications for systematic lymphadenectomy.

Diffuse and gross peritoneal carcinomatosis treated by intraperitoneal hyperthermic chemoperfusion.

Intraoperative intrapeitoneal hyperthermic chemoperfusion (IHCP) offers the following advantages: uniform distribution of heat and drugs at a high concentration in the whole intraperitoneal cavity, heat as a cytotoxic agent itself, and heat as a biomodulator of chemotherapy. Twenty-five patients suffering from diffuse and gross peritoneal carcinomatosis were enrolled into a phase II study to evaluate the feasibility and the efficacy of IHCP. IHCP was carried out with 10 micrograms mitomycin C/ml perfusate in the case of gastrointestinal malignancies or with 50 micrograms cisplatin/ml perfusate in the case of ovarian cancer with malignant ascites. Thirty-two courses of IHCP in 25 patients were eligible in for study of side effects. One patient suffered severe hematologic toxicity, WHO grade 4; two patients suffered severe impairment of renal function, WHO grade 3. Twenty-one patients were eligible for study of the response. Fifteen were classified as having a "favorable clinical response" and in three of them a pathohistologic complete remission was achieved. In only four patients was peritoneal carcinomatosis not influenced by the therapy. Ascites disappeared in 16 out of 19 patients. Tumor markers that were elevated preoperatively in 16 patients returned to normal values in 10 patients postoperatively and dropped more than 50% in three more patients. A remarkable improvement in quality of life was observed in patients who responded to the therapy.