Transcleral Orbital Invasion by a Radiation and Chemotherapy-Resistant Choroidal Metastasis of a Pulmonary Adenocarcinoma

Purpose: To report transcleral orbital invasion by a radiation- and chemotherapy-resistant choroidal metastasis of a pulmonary adenocarcinoma. Design: 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.