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Abstract

Most previous studies aimed at estimating the number of human T-cell leukemia virus type-1 (HTLV-1) carriers in endemic areas have been based on seroprevalence rates in blood donors; however, this may result in underestimation because of the healthy donor effect. People who have health problem do not donate blood. In the present study, the number of HTLV-1 carriers in Nagasaki City was estimated based on the seroprevalence rates in a hospital-based population from Nagasaki University Hospital. In accordance with previous reports, seroprevalence of HTLV-1 was higher in females, and year of birth-specific seroprevalence showed a significant annual decline in both genders (P for trend: <0.0001). The estimated number of HTLV-1 carriers in Nagasaki City was 36,983. The incidence of adult T-cell leukemia/lymphoma (ATLL) among HTLV-1 carriers was estimated using data from the Nagasaki Prefectural Cancer Registry. The estimated annual incidence of ATLL was 61 per 100,000 HTLV-1 carriers, and the crude lifetime risk of the development was 7.29% for males and 3.78% for females. There is a large pool of HTLV-1 carriers aged over 70 years, and a continuing development of cases of ATLL among the elderly is therefore expected.

Parathyroid carcinoma is rare cause (less than 1%) of primary hyperparathyroidism [1]. Typically, higher serum levels of parathyroid hormone (PTH) are seen in parathyroid carcinoma (3 to 10 times, or even higher, the upper limit of the reference range) than in parathyroid adenoma and hyperplasia and are associated with extreme hypercalcemia (>14mg/dL) [1,2]. There may be associated severe bone pain and ossteitis fibrosa cystica [1]. Parathyroid carcinoma is an indolent tumor with low malignant potential and, in general, has a tendency to recur locally in the operative site or spread into contiguous tissues in the neck. Distant metastases are a late phenomenon with lymphatic or hematogenous spread to cervical lymph nodes and lungs and less commonly to the liv- , SHImeru kamIHara 2) anD kaTSumI egucHI er. The optimal treatment for parathyroid carcinoma is complete resection of the primary site, en bloc, including the surrounding tissues. When metastatic parathyroid tumors are found, surgical resection of the metastatic tumors is the optimal treatment. This is because parathyroid carcinoma is refractory to radiation and cytotoxic reagents [1]. medical management of hypercalcemia by infusing large amounts of fluid, along with bisphosphonates and perhaps calcitonin is briefly effective but, hypercalcemia eventually becomes uncontrolable. recently, cinacalcet, a calcimimetic agent [3], has been used effectively to reduce hypercalcemia in patients with primary hyperparathyroidism [4] and ~ two thirds of patients with parathyroid carcinoma also respond [5]. However, this treatment was not available in Japan for our patient in 2007, and, moreover, long-term efficacy has not been well established and calcimimetics do not inhibit proliferation of parathyroid cancer cells.It was recently shown that immunization with PTH peptides was effective in controlling hypercalcemia

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