Breast Condition, Essay Example

Breast Condition

The clinical case presented in the example deals with a 53-year-old African American woman with a palpable lump in her right breast. The differential diagnosis is a breast condition known as a low grade phyllode tumor, and the following paper deals with what this involves, why it is the most likely diagnosis, what treatment involves and strategies for patient education.

Differential Diagnosis: Low Grade Phyllodes Tumor

A good working definition of a phyllode tumor is “an uncommon, biphasic, fibroepithelial lesion of the breast, characterized by leafy stromal fronds capped by benign bilateral epithelium” (Tan, 2011, p. 36).  It is a term that can be given to a range of fibroepithelial conditions and can be benign, borderline or malignant (Wesolowski & Budd, 2010, p. 536).  Phyllodes tumors can present with a number of challenges for the clinician: for one thing, they are very rare, accounting for less than 1% of all breast neoplasms (Tan, 2011, p. 37) and for another, they are very similar to fibroadenomas in both histiology and prognosis, which can make them difficult for a clinician to diagnose (Wesolowski & Budd, 2010, p. 536).

Why Low Grade Phyllodes Tumor is the Most Likely Diagnosis

There are a number of reasons why the diagnosis of a low grade phyllodes tumor of the breast would be the best differential diagnosis. To begin with, the absence of symptoms such as  serosanguinous nipple discharge or nipple retraction, “pea d’orange” discoloration of the skin, or a rash or burning or irritation of the skin or nipple: these are all common presentations of women with breast cancer (Wesolowski & Budd, 2010, p.537).  There are a number of other factors in the patient’s presentation and history that would lean towards a diagnosis of a phyllodeas tumor: the patient has a history of late childbirth, late menopause, and long-term exposure to estrogen and progesterone through her contraceptive pills, all of which are believed to be possible risk factors for developing this kind of growth (Wesolowski & Budd, 2010, p. 538).   She also presents with a history of fibroadenomas, is in her fifties and still menstruating, and has a mass in one breast only, all of which are consistent with this diagnosis (Harrison, et. al., 2010, p. 54).  Statistically speaking, the majority of phyllodes, 50-60%, turn out to be benign. (Harrison, et. al., 2010, p. 55).

Treatment and Management of Low Grade Phyllodes Tumor

The gold standard of treatment for phyllodes tumors remains excision, often with a somewhat wide surgical margin to ensure that all of the mass has been removed; lumpectomies and breast-conserving surgery is common, but for cases of malignant or borderline tumors, mastectomy with or without breast reconstruction may be necessary (Guilliot, et. al, 2011, p. 130).  Guillot notes that the “role of adjuvant therapy is unproven and must be considered on a case by case basis” (Guilliot, et. al., 2011, p. 136).  However, other studies have disputed this, finding that wide-margin excision combined with radiation therapy caused “significantly less” rates of mass recurrence than women who underwent the surgery alone (Barth, J. et. al, 2010, p. 289).

Example Strategies for Patient Education

Patient education is one of the most important aspects of clinician’s job, the ultimate goal being “achieving changes in patient behavior by providing patients with the knowledge they need in order to make decisions about their health care that will improve their outcomes” (Lowenstein, 2010, p. 6).  Strategies for teaching the patient in question could include lectures, question and answer sessions, and use of written, audio-visual or technological media to enhance learning; it was found that teaching which uses a variety of strategies and is culturally competent and patient-centered are most successful (Friedman, et. al., 2010, p.6).

Conclusion

Diagnosis – and sometimes treatment – of phyllode tumors can present challenges to the clinician.  However, a good knowledge of the disease process and the ability to education the patient about this condition can go a long way for improving patient outcomes.

References

Barth, J. et. al. (2010). A Prospective Multi-Institutional Study of Adjuvant Radiotherapy After Resection of Malignant Phyllodes Tumors.  Annals of Surgical Oncology. 16(8) 288-294

Friedman, A.J., et. al. (2011).  Effective Teaching Strategies and Methods of Delivery For Patient Education: A Systematic Review and Practice Guidelines. Journal Of Cancer Education.  26(1) 12-21

Guillot, E. et. al.  (2011). Management of Phyllodes Breast Tumors. The Breast Journal. 17(2) 129-137

Harrison, J. et. al. (2010).  Diseases of the Breast. 4^th Edition. Lippincott, Wilks and Wilson.

Lowenstein, A. et. al. (2010).  Teaching Strategies for Health Education and Health Promotion: Working with Patients, Families, and Communities. Jones and Bartlett.

Tan, H. T., et. al.  (2011). Predicting Clinical Behavior of Breast Phyllodes Tumors: A Nomogram Based on Histiological Data and Surgical Margins.  Journal of Clinical Pathology. 61(1) 36-42

Wesolowski, R. & Budd, B. (2010). A Young Woman with a Breast Mass: What Every Internist Should Know. Cleveland Clinic Journal of Medicine. 77(8) 537-546