Surgical treatment of Stage IIb and IIIa NSCLC invading chest wall by extrapleural or 'en bloc' resection is widely adopted and justified by the good results in terms of morbidity and relief of pain. Survival is always depending on the N status.

Figure 2. Hematoxylin and eosin-stained section reveals dilated vessels with endothelial cells, thrombus, and areas of fat and fibrous tissue (original magnification ؋250).

enign bronchoesophageal fistula (BEF) is rare and may be characterized by nonspecific symptoms that may delay a correct diagnosis. 1 As soon the diagnosis of BEF is made, immediate surgical treatment is necessary to avoid complications. We present 4 cases of benign BEF that we encountered over a 20-year period.

The treatment of benign broncho-oesophageal fistula is usually surgical but sometimes other methods of treatment are preferred. The case history is described of an adult in poor general condition in which an endoscopic approach combined with the use of fibrin glue on the bronchial side and metallic clips on the oesophageal side was used to close the fistula.

sibility of intrathymic metastasis rather than multicentric thymoma development. No other reports of multiple thymoma, however, have inferred that the origin was through intrathymic metastasis because of the small number of tumors, similar sizes, and noninvasiveness. 2,3 This case was a triple thymoma with three different histologic types, and we suppose that these three tumors originated independently from different areas of the thymus, because the histopathologic types are classified according to the normal differentiation of the major functional and anatomic compartments of the thymus. 7 Moreover, hyperplasia of thymic epithelial cells was seen in other thymic tissue of the specimen, although it is not known whether those lesions would grow into a thymoma. From these cases, we suspect that the thymus has a potential to develop multicentric thymomas.Although we performed a total thymectomy in this case, the extent of the excision for thymoma is controversial even when complete resection is accomplished. Nevertheless, we think that a total thymectomy is the best approach to resection for thymoma because there may be multicentric thymomas.