A B C D E 1 2 1 2 Biopsy (incisional) Biopsy (excisional) Figure 1: Time line of the left eye. A) A large central tumor partially hiding the optic disc (*) and involving the fovea with localized vitreous seeds (TNMH group T2b or IIRC group C eye). B) After 2 periocular topotecan injections and 2 intravitreal Melphalan injections (descending Arrows); tumor is still growing with minimal central calcification. The decision of enucleation was taken. C) After 12 weeks post-enucleation, A white mass appeared over the conjunctival surface. D) the mass enlarged after 1 cycle of chemotherapy. E) After mass excision by 6 weeks. C D E

Figure 2: Fluorescein angiography showing minimal uptake of the dye by the mass.

Figure 2: A) MRI performed on first diagnosis showing a poorly defined soft tissue mass with minimal enhancement within the enucleated left orbit along the inferiolateral margins of the prosthesis and the medial, inferior and lateral recti. Recurrent tumor was suggested. B) CT performed on the same day as the MRI showing an enhancing left orbital soft tissue mass (8 mm) between the prosthesis and the socket; infero-laterally intervening the lateral and inferior recti and appear to abut at the medial rectus margin.

* * * Figure 3: Histopathology of the white orbital mass. Scattered round voids (*) (200um in diameter) containing polarizing foreign material. The material is surrounded by chronic granulomatous inflammation including lymphocytes, epithelioid cells and multinucleated foreign body giant cells. No tumor cells can be identified.