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The indication for sleeve lobectomy of the middle lobe is limited, because the frequency of cancer occupying both the middle lobe and its bifurcation is low and the more commonly used middle and lower lobectomy is an alternate procedure. However, if a patient has accompanying cardiopulmonary restriction, lung preservation is paramount. We present a patient with hilar lung cancer (TisN0M0) associated with progressive cardiomyopathy, who underwent sleeve lobectomy of the middle lobe; the cancer took a favorable course.

Primary mediastinal seminoma is an uncommon tumor usually located in the anterior mediastinum. The majority of cases occur in young males. We report here an extremely rare case of a 69-year-old male with primary seminoma in the middle mediastinum. The patient had no complaints, but an abnormal shadow was seen in a routine chest X-ray. We performed a tumorectomy in the middle mediastinum, a thymectomy and an orchidectomy and added postoperative chemotherapy. It seems that the tumor was not associated with the thymus, so we believe the tumor did not stem from the embryonic thymus. Our case demonstrated that mediastinal seminoma does not always occur in the anterior mediastinum of young males. Although this case is rare, seminoma should be included among the possible diagnoses of a middle mediastinal mass.

Full-thickness reconstruction to repair defects in the chest wall was performed with a new method, using Marlex mesh, artificial bones and musculocutaneous flap. The artificial bones were constructed from ceramic iliac crest spacers connected by wires and methyl methacrylate. The advantage of the method is that the artificial bone can be created in various lengths and curves, tailored for the individual defect.

A 47-year-old male patient underwent Bentall's modification with total arch replacement owing to type A acute dissection. Mediastinitis and composite graft infection occurred 3 weeks after the operation. Extensive debridement and irrigation followed by omental wrapping without graft removal were performed and the patient was successfully cured.

We report a case of a 61-year-old man with a tiny thymic carcinoma completely surrounded by thymic tissue. First, a thoracoscopic resection of about two-thirds of the right inferior part of the thymus containing the tumor was performed to obtain the histological diagnosis. Frozen-section diagnosis at operation revealed a thymic carcinoma. Therefore we performed a median sternotomy and resected the remnant of the thymus. A tiny thymic carcinoma completely surrounded by thymic tissue is extremely rare. In this case, as the tumor was tiny and there was a homogeneous mass without a thymoma-like component, we concluded that this tumor was de novo.

The present paper reports a 28-year-old male with an asymptomaticmalignant Triton tumor of the lung. Chest radiographs revealed a mass in the left hilum. The left lower lobe including the tumor and the mediastinal lymph node was resected. There was no metastasis or tumor recurrence during the one-year period following the surgical procedure. To our knowledge, this is the first case report of a primary pulmonary malignant Triton tumor.

Angiosarcoma is a rare but highly malignant disease. This report presents a 22-year-old male who has survived a primary angiosarcoma arising from the chest wall. The patient had been complaining of anterior chest pain for 3 years. CT and MRI revealed a tumor protruding into the right thoracic cavity from the anterior chest wall but no further findings. First, the tumor was resected using video-assisted thoracoscopy. The pathological diagnosis established from a frozen section was of a benign mesothelioma, but this was changed to angiosarcoma based on findings from a paraffin-embedded specimen. As a consequence, the third rib and intercostal muscles were resected in a second operation. Three years following surgery there was no evidence of tumor recurrence or metastasis. This case supports a suggestion that not all patients with angiosarcomas experience the same level of malignancy.