In-vitro proliferation assay with recycled ascitic cancer cells in malignant pleural mesothelioma: A case report

Figure 1 Postoperative recurrence of malignant mesothelioma. A, B: F-18 fluorodeoxyglucose positron emission tomography/computed tomography (CT) showing multiple pulmonary metastases (orange arrows) that occurred 13 mo postoperatively; C: CT showing massive ascites after eight courses of pemetrexed therapy; D: A photomicrograph of mesothelioma cells in the ascitic fluid obtained via abdominocentesis.

Figure 2 Use of KM-cell-free and concentrated ascites reinfusion therapy and collagen gel droplet-embedded culture drug sensitivity test. A: Schema of KM-cell-free and concentrated ascites reinfusion therapy (KM-CART) and collagen gel droplet-embedded culture drug sensitivity test applied in the presented case; B: Image of the KM-CART system used for actual treatment. Ascitic fluid obtained via abdominocentesis (i) was immediately processed using the KM-CART system consisting of an ascites filter (ii), an ascites concentrator (iii), a roller pump (iv), and an aspirator (v). KM-CART: KM-cell-free and concentrated ascites reinfusion therapy; CD-DST: Collagen gel droplet-embedded culture drug sensitivity test.

Figure 3 Collagen gel droplet-embedded culture drug sensitivity test assay of mesothelioma cells obtained from ascites. A: The filtered cancer cells were centrifuged to divide the fluid into a supernatant (i), mucus component (ii), and cell pellet including mesothelioma cells (iii); B: After cell counting, the mesothelioma cells were used to conduct the collagen gel droplet-embedded culture drug sensitivity test (CD-DST). Tumor cells were incubated without any cytotoxic drug; C: Or in the presence of cytotoxic drugs such as D: pemetrexed (PEM) and E: gemcitabine . After the proliferation assay, the final number of cancer cells was quantified using a dedicated system; F: Compared to a normal control, PEM did not reduce cell growth, while gemcitabine reduced the tumor cell growth rate to 21.9%. PEM: Pemetrexed; GEM: Gemcitabine.

Figure 4 A flowchart depicting the timeline of treatment and outcomes. KM-CART: KM-cell-free and concentrated ascites reinfusion therapy; CD-DST: Collagen gel droplet-embedded culture drug sensitivity test.