John C. Neff

Relative value of prostate-specific antigen and prosttic acid phosphatase in diagnosis and management of adenocarcinoma of prostate Ohio State University Experience

Serum concentrations of prostate-specific antigen (PSA), prostate-specific acid phosphatase (PAP), and transrectal prostatic ultrasound were utilized in the evaluation of 193 men with various urologic disorders. Of the 193 patients, 48 had prostate cancer, and the other 145 included 5 with genitourinary neoplasms, 69 with benign prostatic hypertrophy, and 71 with other non-neoplastic genitourinary disease. PSA levels were elevated in 35 patients with prostate cancer and in 25 of the 145 without prostate cancer. PAP levels were elevated in 15 with prostate cancer and in 2 of the 145 without prostate cancer. The data indicate that PSA is a more sensitive but less specific tumor marker than PAP in the detection of prostate cancer. PSA appears to be more sensitive than PAP in monitoring the response to treatment. The use of PSA and PAP jointly to detect and to monitor prostate cancer did not appear to enhance the clinical utility over that of PSA alone.

Use of indirect immunofluorescence in the lupus erythematosus/lichen planus overlap syndrome: an additional diagnostic clue

The lupus erythematosus (LE)/lichen planus (LP) overlap syndrome comprises a heterogeneous group of patients who demonstrate clinical, histologic, and immunopathologic characteristics of two diseases. We report six patients with the syndrome who were evaluated by a double-layer indirect immunofluorescence (IF) technic using patient serum and autologous lesional skin as substrate followed by conjugate. This test demonstrated intense staining of the stratum granulosum in two patients, a finding previously shown to be consistent with LP. A third patient developed criteria for the diagnosis of systemic LE with corroborating direct IF findings and a negative indirect IF assay. This preliminary study provides evidence for a possible way of distinguishing LE from LP in some patients with the overlap syndrome.

Bullous lichen planus: Diagnosis by indirect immunofluorescence and treatment with dapsone

Bullous lichen planus may be confused with other subepidermal bullous dermatoses, especially if bullae arise on normal-appearing skin. We present two patients who were originally thought, on the basis of clinical and histopathologic criteria, to have bullous pemphigoid. However, results of standard indirect and direct immunofluorescence assays did not support the diagnosis of bullous pemphigoid. Further investigation using the indirect autologous immunofluorescence assay revealed deposits of immunoglobulins in the stratum granulosum. Moreover, the indirect allogeneic immunofluorescence assay (using papular lichen planus lesional substrates from different patients) was positive for the same pattern, confirming the diagnosis of bullous lichen planus. Bullous lichen planus with bullous pemphigoid-like histologic features can be differentiated from bullous pemphigoid on the basis of the indirect autologous and allogeneic immunofluorescence assays for circulating antigranulosum antibodies. Both patients were treated with systemic corticosteroids. One patient went into remission with this therapy alone; the other patient had a favorable response when dapsone was given with systemic corticosteroids. The suggestion that there is a subset of bullous lichen planus with bullous pemphigoid-like histologic features that responds to dapsone needs to be explored.