Recently we resected and reconstructed the sternum in two female patients with thyroid carcinoma metastatic to the sternum. Histological diagnosis of the metastatic lesion was follicular carcinoma in the first case and papillary carcinoma in the second case. Reconstruction of the sternum was accomplished by using an acrylic resin plate alone in the first case and an acrylic resin plate sandwiched between layers of Marlex mesh (Marlex sandwich procedure) in the second case. In the first case the acrylic resin plate was directly fixed to the ribs with metallic wires, most of which snapped off later, and a small amount of exudate accumulated around the plate for a short period of time. In contrast, the postoperative course in the second case was uneventful and the Marlex sandwich procedure seemed superior in the chest wall reconstruction following resection of the sternum.

Preoperative bronchoscopic findings of thyroid carcinoma with tracheal invasion were examined and compared with the histopathological findings. Tracheal sleeve resection was performed in 20 cases. The bronchoscopic findings were classified into 5 types: confirmed tumor in the tracheal lumen (5 cases), extramural compression of the trachea plus mucosal change (9 cases), extramural compression of the trachea (2 cases), mucosal changes only (3 cases), normal findings (1 case). Pathological findings revealed that the extent of invasion in the tracheal wall varied according to each of the above bronchoscopic types. The number of tracheal rings with adventitial invasion averaged 0.8 (maximum 2) more than preoperative bronchoscopic findings of the number of tracheal rings with mucosal invasion. This study demonstrated the necessity of resective 2 more tracheal rings than is indicated by the bronchoscopic findings.

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Incidence of esophageal cancer among patients with head and neck cancer was estimated as about 1%. Recently, we had a rare case with double cancer of metachronous multiple tongue cancer and synchronous multiple superficial esophageal cancer .A 48 year old man admitted the hospital for his tongue ulcer. He had underwent partial resection and irradiation of tongue cancer 4 years before. Further examination revealed epidermoid carcinoma at tongue ulcer and multiple superficial esophageal cancer. The tongue cancer was estimated as metachronous multiple cancer, because the lesion occupied opposite side of the tongue to the former tumor and there suspected no continuity between them .Partial resection of the tongue and total thoracic esophagectomy were carried out. Histological studies on resected specimens disclosed the tongue cancer as T1NO (stage I) and five esophageal cancers as superficial cancer (3 mucosal cancers, and 2 submucosal cancers) .There found only one lymphnode metastasis at para-tracheal node (n=1/98). Postoperative chemotherapy was carried out using CDDP 50 mg, MTX 30 mg and BLM 15 mg, and it repeated four times. Post operative course was uneventful.