Orbital leiomyoma mimicking a cavernous hemangioma

Orbital leiomyoma is a rare benign tumor of the smooth muscles of the orbit with intraconal or extraconal location. The tumor affects twice as many men as women, with an average age of 30 years.

A 38-year-old female presented with proptosis: Axile, nonpulsatile, painless, nonreducible, Grade III, with impairment of oculomotricity, associated with a decrease in visual acuity on the affected side with an AV at 03/10, and fundus: Grade I papilledema. The computed tomography scan showed a solitary, tissue mass, well-limited, encapsulated, and usually homogeneous, with homogeneous enhancement after contrast injection. The magnetic resonance imaging showed a rounded, homogeneous lesion, isointense on T1 and hyperintense on T2, with homogeneous enhancement after gadolinium injection. Suggestive of an intraorbital cavernous hemangioma. The patient underwent surgery via a subfrontal approach, with macroscopically complete resection. Histopathological examination was in favor of an orbital leiomyoma.

Although very rare, orbital leiomyoma should be considered in the differential diagnosis of patients with orbital tumors.