PMC10351532_01
(A) is a HE-stained sample (LM x200): a large amount of glandular tumor cells was seen to be arrayed as papillae, and the cells appeared to be vacuolated and had enlarged nucleus, round shape, nucleolus, and basophilic cytoplasm. (B) and (C) are immunostained figures (LM x400); (B) is CK7 (+), and (C) is ER (+).
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Cytology analysis of the ascites discovered a large amount of glandular tumor cells arrayed as papillae, and the immunohistochemistry results were CK7 (+), ER (+), PAX-8 (+), P53 (+), CK20 (-), CDX-2 (-) (Figure 1). Considering the medical history, the patient was diagnosed as post-operative recurrence of the ovarian serous carcinoma. 
(A) Ascites organoid culture of recurrent ovarian cancer on day 0: in the microscopic view, multiple cell clusters were seen, and the cells were in rather good condition. (B) Ascites organoid culture of recurrent ovarian cancer on day 1: overall reproduction was rapid, and the general condition of the cell were well. The greatest diameter for the organoid was 155mum. Magnification of (A and B)x20.
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To facilitate precise medicine for the patient, patient ascites-derived tumor organoids (PDTOs) were generated and PTDO drug sensitivity assay was conducted (Figure 2).
Comparison of tumor IC50 of ascites organoid from recurrent ovarian cancer. (A) displays the IC50 of doxorubicin hydrochloride, gemcitabine hydrochloride, and topotecan hydrochloride; (B) displays the IC50 of fluzoparib, olaparib, and niraparib hydrochloride, and (C) displays the IC50 of the combination of cisplatin and paclitaxel, and the combination of carboplatin and paclitaxel. The drug with the lowest IC50 is considered to be the most effective choice.
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The drug sensitivity results suggested that chemotherapy drugs topotecan, gemcitabine and targeted therapeutic drugs niraparib and Fluzoparib may exhibit clinical anti-cancer effect as the IC50 values of these drugs were 0.56, 0.81, 0.5 and 0.60, respectively (Figure 3).
Comparison of tumor inhibitory rate of ascites organoid from recurrent ovarian cancer.
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The tumor cell inhibitory rates and IC for topotecan and niraparib were 94.29% and 99.39%, and 0.56 and 0.50, respectively (Figure 4).   
CA125 value before and after the precise individualized treatment: before the establishment of ascites-derived organoid, CA125 was on a rise lately despite of the initial treatment; after the individualized precise treatment based on the established ascites-derived organoid, CA125 value decreased gradually.
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After 3 cycles of combination therapy (topotecan 200mg, intravenous chemotherapy, 1 day + carboplatin 300mg, intravenous chemotherapy, 1 day + bevacizumab 400mg, intravenous chemotherapy, 1 day, every 21 days), the serum CA125 level decreased from 225.8 to 33.7 U/mL (Figure 5). 
(A-C) PET-CT scan from July 6th, 2021, when the recurrence of the ovarian cancer was first detected; (A and C) PET revealed abnormal intake of FDG, indicating new-onset metastases in the pelvic and left inguinal lymph nodes, as well as in the muscle of psoas major, iliacus, and iliopsoas; (B) Axial-CT revealed effusion within the pelvic cavity, and red arrows in (B) indicates the condition of ascites before the treatment; (D-F) PET-CT scan from December 27, 2021, after the individualized treatment based on the medication sensitivity of the organoid: (D) Axial-PET found decreased FDG intake, indicating metastatic tumor sites within the pelvic cavity shrunk partially; (E) Comparing with figure (B), the axial CT found apparent reduction of effusion within the peritoneal-pelvic cavity, and red arrows in figure (E) points to the area that shows the condition of the ascites after the treatment; (F) PET found shadowing areas around the Hip joint, but there was no signs suggesting increased FDG intake; therefore, it was considered to be a benign lesion, namely, left hip synovitis.
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In addition, a partially shrink of the metastatic tumor sites within the pelvic cavity was observed (Figure 6). 
Case timeline.
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