Lower eyelid angioleiomyoma: a rare case of a slowly progressive orbital tumor with a 10-year history.

Angioleiomyoma is a rare benign vascular smooth muscle tumor, exceptionally reported in the orbit and peri-orbital region with fewer than 25 cases documented. We report a case of a 60-year-old male presenting a slowly progressive, painless lower eyelid mass evolving over 10 years. Clinical examination revealed a well-circumscribed 15 mm lesion. Angio-computed tomography (CT) demonstrated a 22 × 24 × 18 mm well-circumscribed mass with peripheral contrast enhancement, consistent with a vascularized lesion. Surgical excision via a subciliary approach was performed. Histopathological analysis showed a 15 × 10 mm tumor composed of smooth muscle bundles surrounding vascular channels. Immunohistochemistry was positive for smooth muscle actin and desmin, confirming the diagnosis of angioleiomyoma. No recurrence was observed during a 3-year follow-up. The absence of magnetic resonance imaging (MRI), due to patient financial constraints, constitutes a limitation discussed herein. This case highlights the diagnostic challenge and the importance of considering angioleiomyoma in differential diagnoses of eyelid masses.