a 22-year - old - male patient presented with a painless swelling over the left eye along with mechanical ptosis of the upper lid .
the mass was located anterior to the orbital rim in the superolateral part of the orbit ; with the posterior edge not palpable as it was within the orbit .
anterior segment evaluation , intraocular pressure , and fundus examination of both eyes were normal .
a computed tomography showed an iso - to - hypodense mass lesion in the superotemporal aspect of the left orbit , arising possibly from the lacrimal gland since the gland could not be clearly delineated from the mass .
no obvious changed to the bony orbit could be noted on the scans [ fig .
fine needle aspiration cytology smears drawn showed no malignant cells ; however , a conclusive diagnosis could not be made .
a working diagnosis of a pleomorphic adenoma of the lacrimal gland was made , and an excision biopsy was performed .
intraoperatively , the mass was pink , vascular , and well circumscribed but not encapsulated .
the lacrimal gland was seen in close relation to the mass , compressed between the mass and the superolateral orbital bony rim .
( a ) external clinical photograph shows the mass located in the superolateral quadrant of the orbit .
( b ) axial slice of the computed tomography scan showing the mass in the vicinity of the lacrimal gland ( yellow arrow ) the cut surface was homogeneous and did not have any distended vascular channels , lacrimal tissue , or cystic dilatations . on microscopic examination ,
spindle cells in compact sheaves closely opposed to thin walled vessels were seen in a fibrocollagenous background [ fig .
the nuclei were open , oval , and contained small , uniform nucleoli [ fig .
. no necrosis was noted , and a few engorged vessels were seen in the outlying area .
immunohistochemical studies showed that the tumor cells stained positive for cd 34 and cd 31 , which are markers for endothelium [ fig .
furthermore , the tumor stained positive for smooth muscle actin and negative for cd68 [ fig .
immunostaining was negative , and the ki-67 proliferation index was low with < 5% of the cells staining positive [ fig .
thus , the tumor had no conclusive features of a malignancy and the final diagnosis based on its microscopic appearance , and immunohistochemical characteristics was that of a solid variant of angioleiomyoma of the orbit . as it had been excised completely , no further treatment was warranted . at 1-year follow - up , no recurrence was observed .
( a ) low power view showing spindle cells in a background of fibrocollagenous tissue ( h and e , 10 ) .
( b ) high power view demonstrating uniform oval nuclei ( h and e , 40 ) ( a and b ) immunohistochemical studies showed that the tumor cells stained positive for cd 34 ( endothelium ) and cd 31 ( 10 ) ( a and b ) immunohistochemical studies positivity for smooth muscle actin and immunonegativity for cd68 ( 10 ) .
( c ) the ki-67 proliferation index was low with < 5% of the cells staining positive ( 10 )
the differentials for such an orbital tumor could be cavernous hemangioma , angiomyofibroma , or complex orbital angiomyoma . the tissue of origin of angioleiomyoma is considered to be smooth muscle ; so the possible native tissues from which the tumor could have arisen include blood vessels , pericytes , mller 's muscle or the capsulopalpebral muscle of hessar .
angioleiomyoma is well recognized within the spectrum of vascular lesions of the soft tissues and has been subdivided into three types  solid , venous , and cavernous .
since there were no dilated cavernous spaces within our tumor , we consider our case to be a solid variant .
morimoto , who classified angioleiomyomas , observed that solid variants are often painful and seen in the extremities .
in contrast to his comments , our case was a solid variant which was painless .
described an angiomyofibroma of the orbit as a hybrid tumor exhibiting characteristics of a vascular leiomyoma and cavernous hemangioma .
the lack of the cavernous venous channels , the unusual location , and absence of the classical purplish hue rule out cavernous hemangioma and angiofibroma in our case .
jakobiec has also described in detail the characteristics of a complex orbital angiomyoma , which had features of a lymphangiohemangioma .
three of them were located in the muscle cone , two of them were located in the superotemporal orbit , and one was located in the inferior orbit .
two other eyelid angioleiomyomas were also described in the same series . of these eight cases ,
based on their histological classification , however , only one case was the same type as our case : the solid variant ; five cases were of the cavernous type and two cases were venous type .
alam et al . , have also reported a similar tumor from the anterior orbit , which was found to be of the cavernous subtype .
preoperative magnetic resonance imaging may provide some clues : magnetic resonance findings of peripheral angioleiomyomas were relatively nonspecific , but t2-weighted images show a mass with mixed areas that are both hyper- and iso - intense relative to the skeletal muscle and a hypointense rim .
angioleiomyomas of the orbit are rare tumors with good prognosis , and the treatment of choice remains complete surgical excision .
 we describe the clinicopathological features of a solid variant of orbital angioleiomyoma . 
 a review of clinical records , diagnostic , and radiographic studies combined with histopathological evaluation with standard histochemical staining and immunohistochemistry was conducted . a 22-year - old male patient presented with a mass in the region of the left lacrimal gland that was gradually increasing over the past 2 years . 
 radiological and clinical examinations showed no signs suspicious of a malignancy and fine needle aspiration cytology was inconclusive . therefore 
 , an excision biopsy was performed . 
 on histopathological examination , the picture was consistent with a benign spindle cell tumor . immunohistochemistry showed positivity for cd 34 and cd 31 ( markers for vascular endothelium ) . 
 the tumor also showed positivity for smooth muscle actin and ki-67 proliferative index was low . 
 angioleiomyomas are rarely encountered in the orbit and has features seen in leiomyoma as well as some vascular tumor elements . in most cases , surgical excision is usually curative . 