Possible involvement of brain tumour stem cells in the emergence of a fast-growing malignant meningioma after surgical resection and radiotherapy of high-grade astrocytoma: case report and preliminary laboratory investigation.

The case of a 62-year old man diagnosed with radiation-induced meningioma (RIM) after treatment for astrocytoma with an unusually short latency period of 7 months is reported. The patient first presented with a 2-month history of memory decline. Magnetic resonance imaging (MRI) showed a tumour in the left parieto-temporal lobe. Gross total resection was performed and the tumour was confirmed to be an astrocytoma. The patient received cranial radiotherapy 2 weeks later, however 7 months after radiation treatment the patient presented with headache and vomiting. MRI showed massive meningeal enhancement in the left frontal lobe, which progressively enlarged. The patient's clinical condition deteriorated and a second craniotomy was performed with complete removal of the secondary tumour, which was shown to be a malignant meningioma. Immunohistochemical staining identified CD133-positive cells in both tumours. A rare fraction of brain tumour stem cells (BTSC) was isolated from the primary astrocytoma using a serum-free culture system, suggesting that BTSC may have been involved in the rapid emergence of RIM after resection and radiation of the primary astrocytoma.