Case report: intracranial lesions in a patient with anxiety and depression: tumor recurrence or radiation encephalopathy?

Abstract

Purpose: Radiation encephalopathy (REP) is one of the most common complications of radiotherapy for malignant tumors of the head and neck. Symptoms usually appear months to years following radiotherapy, with headache, insomnia, and memory loss as the main clinical features. We report a patient who was admitted to the hospital with anxiety and depressive disorder and was eventually diagnosed with REP.

Patients and methods: A 48-year-old patient who had undergone over 2 years of radiotherapy for nasopharyngeal carcinoma was admitted to the Department of Psychosomatic Medicine of our hospital because of recurrent fear, low mood, and waking up from dreams. Magnetic resonance imaging (MRI) revealed a mass in the left temporal lobe with a large peripheral edema. After multidisciplinary consultation, the possibility of tumor recurrence could not be excluded.

Results: Resection of the lesioned brain tissue to obtain pathological tissue showed glial cell proliferation and small focal areas of degeneration and necrosis, which indicated that the lesions were inflammatory. Postoperative MRI showed no abnormal signal, and the patient's condition improved.

Conclusion: Nasopharyngeal carcinoma patients with a history of radiotherapy and symptoms of increased intracranial pressure and neurological damage should be examined for REP. Furthermore, patients may experience anxiety and depressive disorders as a result of temporal lobe damage caused by REP.

Keywords: anxiety disorders; depressive disorders; nasopharyngeal cancer; radiation encephalopathy; radiotherapy.

Figure 1

Clinical pictures of patients. (A) Cranial T2 fluid-attenuated inversion recovery sequence magnetic resonance imaging scan showing an irregular mass of abnormal signal in the anterior portion of the left temporal lobe. The borders between the mass and surrounding tissue are not clear. (B) Abnormal signal disappeared after resection of lesioned tissue. (C, D) Brain histopathology showing extensive degeneration and necrosis of glial cells, hyperplasia of peripheral glial cells, and infiltration of peripheral lymphoid tissue.