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Thymic epithelial tumors are mainly consisted of thymoma, thymic carcinoma, and thymic carcinoid. And thymic carcinoma is very rare neoplasm. The classification of thymic carcinoma has remained a subject of controversy for many years. The outline of thymic carcinoma has been clarified by "Atlas of Tumor Pathology: Tumors of the Mediastium (AFIP)" and "Histrogical Typing of Tumours of the Thymus (WHO)" published recently. Squamous cell carcinoma is by far the most common in Japan. Thymic carcinoma is a predilection for male. The peak of age was 40-60 years. Thymic carcinoma already had contiguous invasion around neighbor organs, dissemination, and lymph node metastases or distant metastases at diagnosis. Two third of patients with thymic carcinoma performed surgery, and most of them performed adjuvant radiotherapy or chemotherapy. 5-year survival of thymic carcinoma was 33-50%. Histologic tumor type, type of tumor margin, growth pattern, nuclear atypia, necrosis and mitotic activity were correlated with survival. In this paper thymic carcinoma is reviewed mainly based on recently literatures and results obtained from a questionnaire on thymic epithelial tumors in Japan.

We considered 33 patients to have a multiple primary lung cancer (MPLC) at our hospital from January 1986 to August 2001. We used the criteria of Martini and Melamed for MPLC. Sixteen patients developed metachronous cancer within 0.8 to 9.4 years of the first operation (mean 4.2 years), while 17 patients had synchronous cancers. The most common histologic pair was squamous cell carcinoma-squamous cell carcinoma (45%). The next was adenocarcinoma-adenocarcinoma (21%). Stage I lesions occupied 80% of all lesions. Nine patients underwent lobectomy, while 9 patients underwent surgery including a limited operation. Eleven patients had non-surgical local treatment including photodynamic therapy (PDT), brachytherapy, and radiation therapy. Five-year survival for patients with synchronous and metachronous disease from second operation was 36.1% and 40.1%, respectively. Survival of patients including only stage I non-small cell lung cancer (NSCLC) lesions was significantly better compared with those including stage II or III NSCLC and SCLC lesions (p = 0.002). Therefore it is very important to perform close follow-up surveillance for early detection of cancer.

A 54-year-old female with incomplete type of Behçet's disease was operated on because of impending rupture of the thoracic aneurysm. There was a saccular pseudoaneurysm below the left subclavian artery, and a punched out lesion of the aorta was recognized. The defect of the aortic wall was closed with a PTFE patch. Before and after the operation, we have given prednisolone. The postoperative course was uneventful. Two years later, there was no recurrence of pseudoaneurysm near the PTFE patch. In many reports, aneurysms of Behçet's disease are saccular pseudoaneurysms, and have high incidence of complications about anastomosis postoperatively. We need a further follow-up about this patient.

The treatment of thymoma, thymic cancer and thymic germ cell tumor was reviewed in the literature. The major treatment of thymoma is surgery with or without radiation. The chemotherapy for the thymoma is now investigated in the world. CDDP, ADM, VCR, CPA or BLM are usually used, but the most effective combination of these drugs is not known. Thymic cancer is a rarer and more malignant disease than thymoma. Though the postoperative treatment is investigated as well as thymoma, only a few successful cases by chemotherapy have been reported. Chemotherapy (PVB, VAB-6, PEB) for testicular germ cell tumor is also effective for thymic germ cell tumor including seminoma. Though the combination therapy of radiation and surgery has been popular, chemotherapy will be used more frequently for seminoma in future.