title: Transcleral orbital invasion by a radiation and chemotherapy-resistant choroidal metastasis of a pulmonary adenocarcinoma.
abstract: OBJECTIVE
  To report transcleral orbital invasion by a radiation- and chemotherapy-resistant choroidal metastasis of a pulmonary adenocarcinoma.
  
  
  METHODS
  Interventional case report.
  
  
  METHODS
  A 51-year-old female was found to have choroidal metastasis from a previously unknown primary pulmonary adenocarcinoma. She underwent external beam radiation treatment with a total dose of 40 Gray (Gy), delivered in 20 fractions over 28 days, followed by adjuvant chemotherapy with gemcitabine and carboplatin. After completing two of the three scheduled chemotherapy cycles, the choroidal lesion was observed to have increased in size.
  
  
  RESULTS
  A transvitreal aspiration biopsy of the choroidal lesion confirmed the diagnosis of metastatic pulmonary adenocarcinoma. Enucleation was performed for intractable pain. Histopathology revealed invasion through scleral emissary channels to the retrobulbar tissue and through the optic nerve substance itself.
  
  
  CONCLUSIONS
  Despite appropriate external beam radiation therapy (EBRT) and chemotherapy, pulmonary adenocarcinoma metastases to the choroid can continue to grow and may invade the orbit transclerally.
authors.affiliation: Department of Ophthalmology, Mayo Clinic and Mayo Foundation, and Mayo Clinic College of Medicine, Rochester, Minnesota, USA. harrup_kaur@hotmail.com
authors.forename: Harrup
authors.initials: H
authors.lastname: Kaur
authors.forename: Helmut
authors.initials: H
authors.lastname: Buettner
authors.forename: Diva R
authors.initials: DR
authors.lastname: Salomao
authors.forename: Randolph S
authors.initials: RS
authors.lastname: Marks
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002830:Choroid Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004351:Drug Resistance; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009918:Orbital Neoplasms / Q000473:pathology*; D011836:Radiation Tolerance; D011879:Radiotherapy Dosage; D012590:Sclera / Q000473:pathology*; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D016190:Carboplatin; D000093542:Gemcitabine