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Thymic carcinomas are rare neplasm. The standard treatment for advanced thymic carcinoma has not yet been established, and the prognosis is poor. We report 3 cases of thymic carcinoma involving major vessely. Case 1:The aortic arch and the innominate vein were involved. Case 2:The left brachiocephalic vein was involved. Case 3:Tumor invaded to superior vena cava. Complete resection of the tumor was possible with vascular reconstruction.

Twenty years after making an arteriovenous shunt in the left arm, a 45-year-old man on hemodialysis developed progressive swelling in the face to left arm and venous dilatation on the left anterior chest. Venogram disclosed severe stenosis of the left innominate vein at the junction of the superior vena cava, which was considered to be a primary lesion because he had no history of subclavian vein cannulation or mediastinal disease. Surgical resection of the stenotic lesion and direct anastomosis of the innominate vein resulted in a rapid recovery of the symptom of venous hypertension. This is a rare case of hemodialysis-associated large vein complication leading to superior vena cava syndrome.

This case report describes a 59-year-old female patient with superior vena cava syndrome due to large thyroid cancer involving both innominate veins and left common carotid artery. The tumor was resected together with the both innominate veins and left common carotid artery. Right innominate veins and left common carotid artery were reconstructed with FEP-Ringed grafts. Microscopical finding was papillary carcinoma and its lymph node metastasis. Postoperative course was uneventful relatively. Three years after operation the patient is good health without any sign of recurrence.

A 62-year-old woman suffering from lung cancer of the left upper lobe has a tumor invaded the distal border of the left innominate vein. We resected the vein through trapdoor thoractomy combined with resection of the first rib, followed by a left upper lobectomy through posterolateral thoracotomy. Trapdoor thoracotomy combined with first rib resectioning thus proved useful to resect lung cancer invading the distal border of the innominate vein.

A series of 24 patients with stage III and IV thymomas and thymic carcinomas were reviewed with respect to the invasiveness of the superior vena cava (SVC) and brachiocephalic veins (BCV). Masaoka staging revealed stage III disease in 14 patients and stage IV in 10. Follow-up ranged from 3 months to 12 years and 10 months. In 9 patients with stage III disease involving the great veins, 6 patients underwent total resection, 2 subtotal resection, and one exploratory thoracotomy. Reconstruction of SVC was done in 2 patients and of left BCV in 7 and angioplasty of SVC in one. Although there were 4 tumor deaths and one myasthenic death, 4 patients were alive and tumor free. The longest survival after total resection with SVC replacement was 11 years and 7 months. In 3 patients with stage IV disease invading the great veins, 2 patients underwent partial resection and one received radiotherapy alone. Although 2 patients died of generalized metastases and respiratory failure respectively, one remained alive 2 years and 2 months with carcinoma. Although long-term survivors were obtained in the patients with adventitial involvement, prognosis was poor in the patients with intimal invasion.

The usefulness of CT and MR imaging (MRI) for the diagnosis of post-aortic left brachiocephalic vein (PALBV) is discussed. The subjects of the present study consisted of five patients with PALBV, two males and three females, aged four months to sixty years. Chest CT and MRI were performed as a follow-up study of other intrathoracic lesions in two cases, and for further examination of congenital heart diseases in two infant cases. The other patient underwent both CT and MRI to evaluate sporadic chest pain. Therefore, all PALBV were found incidentally. PALBV passes below the aortic arch in front of the trachea, draining the superior vena cava behind the ascending aorta. This finding was particularly well documented on consecutive coronal sections on MRI. In patients with intrathoracic malignant or specific inflammatory lesion, differentiation between PALBV and lymphadenopathy is necessary for treatment. From our experience, marked enhancement on CT and no signal intensity on MRI in PALBV could differentiate this anomaly from mediastinal lymphadenopathy. In two infantile cases with congenital cardiovascular anomalies such as tetralogy of Fallot, right aortic arch and pulmonary arterial stenosis, MRI was found to be superior to CT in demonstrating these anomalies.

The patient was a 58 years old female with invasive thymoma, which invaded the left brachiocephalic vein, left subclavian vein, pericardium and left lung. These invaded organs were resected with the tumor, and a vascular reconstruction was performed between the left axillary vein and the superior vena cava by means of an expanded polytetrafluoroethylene graft. In order to expose the entire length of the left brachiocephalic vein and left subclavian vein, anterolateral thoracotomy at the first intercostal space and resection of the first rib was performed in addition to the median sternotomy. This method can be used in the resection and reconstruction of a subclavian vein invaded by an anterior mediastinal tumor.

A 66-year-old male was referred to our department with mediastinal tumor. The chest X-ray and the chest CT showed a large tumor adjacent to pulmonary artery and descending aorta. Cavogram revealed a filling defect of the SVC. He underwent complete resection of the tumor, resection of the SVC and reconstruction of the SVC with ringed PTFE. The main tumor was 12 x 7 cm in size and the tumor in the SVC was 20 x 15 mm in size. Histopathological findings showed a lymphocytic thymoma. Compact invaded nest of tumor cell was found in the innominate vein. The tumor in the SVC was invasive to the intima of the SVC, but its media and adventure were intact. This case is rare among patients with invasive thymoma as far as the growth is concerned.

An anomalous case of a left brachiocephalic vein passing behind the ascending aorta was observed in a 49-year Japanese man. This is known as anomalous left brachiocephalic vein. The anomalous left brachiocephalic vein descended along the left mediastinum in a position identical to that of a persistent left superior vena cava, so the diagnosis of this venous abnormally require carefully considered. Many cases of anomalous left brachiocephalic vein have been reported based on autopsy findings, but this venous anomaly was recently demonstrated by ultrasonography, CT, and MRI.

A 41-year-old male visited with chief complaints of chest pain and cough. The patient was operated on under a diagnosis of invasive thymoma. The tumor was located in the left lobe of the thymus and measured 6 X 9 cm. Since the tumor invaded the left innominate vein, pericardium, and the upper lobe of the left lung, we resected it with adjacent structures. Postoperative pathological examination indicated squamous cell carcinoma of the thymus. Because the tumor metastasized also to the mediastinal lymph nodes, the patient was treated postoperatively by radiation therapy and adjuvant chemotherapy mainly with CDDP. The patient is well presently 2 years after operation without signs of recurrence.