Editorial

Can Medicine be Compared with Art?

Authors: Laurent Bertoletti, MD

Abstract

The practice of medicine is often described as an art, albeit a difficult one. I believe the report by Uskul et al1 published in this issue has two points of interest: a scientific one and an educational one.


The report first emphasizes the difficulty of diagnosing proximal airway tumors. This difficulty is increased in cases of young people, and with benign or slowly growing tumors. A malignant tumor is easily suspected in a smoker over the age of 55 years with asthenia, anorexia, and weight loss; however, a tracheal lesion as a typical carcinoid tumor may be asymptomatic for a long time or only induce cough. Bronchial carcinoid tumors are rare neuroendocrine tumors, accounting for less than 5% of all bronchopulmonary tumours.2 In a previous report,3 my colleagues and I found that the most frequent symptoms in patients with tracheal or bronchial carcinoid were cough and dyspnea, and the delay between the onset of the symptoms and the diagnosis was, unfortunately, more than a year. In one of the main clinical studies published,4 bronchial obstruction signs were present in 41% of the patients, followed by cough (35%) and hemoptysis (23%).

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References

1. Uskul B, Turker H, Dincer I, et al. A primary tracheal carcinoid tumor masquerading as chronic obstructive pulmonary disease. South Med J 2008;101:546–549.
 
2. Davilla DG, Dunn WF, Tazelaar HD, et al. Bronchial carcinoïd tumors. Mayo Clin Proc 1993;68:795–803.
 
3. Bertoletti L, Elleuch R, Kaczmarek D, et al. Bronchoscopic cryotherapy treatment of isolated endoluminal typical carcinoid tumor. Chest 2006;130:1405–1411.
 
4. Fink G, Krelbaum T, Yellin A, et al. Pulmonary carcinoid: presentation, diagnosis, and outcome in 142 cases in israel and review of 640 cases from the literature. Chest 2001;119:1647–1651.
 
5. Hage R, de la Riviere AB, Seldenrijk CA, et al. Update in pulmonary carcinoid tumors: a review article. Ann Surg Oncol 2003;10:697–704.