Paratesticular leiomyosarcoma is a rare malignant tumor with diagnostic and therapeutic challenges due to its nonspecific presentation and lack of standardized protocols. We report the case of a 44-year-old man presenting with a left scrotal mass managed with fertility-sparing surgery and adjuvant therapy. Pathological analysis confirmed grade II leiomyosarcoma. Multidisciplinary management emphasized the balance between oncological control and fertility preservation. This case underscores the importance of personalized approaches in rare neoplasms, by relying on imaging, negative surgical margins, and adjuvant therapies in improving outcomes.

Paratesticular

Leiomyosarcoma

Soft tissue sarcoma

Rare tumor management

Fertility

© 2025 The Authors. Published by Elsevier Inc.