Paratesticular tumours make up less than 5% of intra-scrotal tumours and of these, approximately 30% are malignant tumours with sarcomas accounting for the majority.
Leiomyosarcoma is a malignant tumour arising from soft tissues containing smooth muscle. They are reported as comprising between 5-30% of paratesticular sarcomas1,2. It is extremely rare that they arise from tissue other than the spermatic cord or epididymis.
We describe such a case of paratesticular leiomyosarcoma in a fifty-four year old man who presented with a six month history of a painful testis and who subsequently underwent radical inguinal orchidectomy and high ligation.