Extratesticular leiomyoma arising from the epididymis: Diagnostic challenges in a chronic scrotal mass

Extratesticular leiomyoma of the epididymis is a rare benign extratesticular tumor that may mimic malignancy clinically and radiologically. This a case report of a 64-year-old male presenting with painless, left scrotal swelling of six years duration. Imaging demonstrated a well-circumscribed extratesticular epididymal mass suspicious for a fibrous neoplasm. Due to inability to exclude malignancy pre and intra-operatively, left high inguinal orchiectomy was performed. Histopathology confirmed benign leiomyoma composed of spindle cells without atypia or mitosis. This case highlights the diagnostic challenges posed by extratesticular masses and emphasizes considering benign differentials to potentially avoid unnecessary radical surgery in patients preoperatively.