A Rare Paratesticular Leiomyosarcoma Presenting as a Painless Scrotal Mass in an Elderly Patient: A Case Report

Leiomyosarcomas (LMS) are malignant tumors originating from smooth muscle and rarely found in the scrotum. LMS has an insidious presentation that is often misdiagnosed as a benign lesion. This report outlines an innocuous case of paratesticular leiomyosarcoma while focusing on the diagnosis and treatment paratesticular LMS. We report the case of an 84-year-old male who presented with a painless left scrotal swelling of 5 days’ duration. Imaging and tumor markers suggested a paratesticular mass suspicious for malignancy. Surgical excision revealed a Fédération Nationale des Centres de Lutte Contre le Cancer Grade 2 leiomyosarcoma arising from the scrotal soft tissue, confirmed by positive smooth muscle markers on immunohistochemistry. Postoperative imaging demonstrated no recurrence at 8 months. This case highlights the diagnostic challenge of paratesticular leiomyosarcoma and the importance of surgical resection and careful follow-up for optimal patient outcomes.