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Paratesticular leiomyomas are rare tumors and originated from the subcutaneous smooth muscles and tunica dartos. Patients usually present with the complaint of a long-standing palpable painless mass and it is important to differentiate it from testicular masses. A 35-year-old male patient presented to our clinic with a palpabl mass, which he has realized since 15 year-old in scrotum that it growth 3-4 times over the last month. Physical examination revealed a palpable solid mass of approximately 3 cm, regular bordered, painless and localized inferiorly in the scrotum. Scrotal Doppler ultrasonography scan showed a 3x2.5 cm solid mass localized inferiorly in the scrotum, which has an internal blood supply. The inguinal exploration was planned due to malignancy risk. When the inguinal exploration was performed, we observed that the paratesticular mass was not connected with the testis. The mass, which was adherent to the scrotal skin, was excised together with the scrotal skin tissue with a safe surgical margin. In the pathology report, it was diagnosed as leiomyoma. The treatment for the vast majority of scrotal masses is radical inguinal orchiectomy. Testis preserving surgical procedures performing is critical for protecting both the fertility and the hormonal level of patients who have benign scrotal masses. Although physical examination suggests malignant neoplasms in patients presenting with a paratesticular mass, it should be kept in mind that benign neoplasms may also be present. [ABSTRACT FROM AUTHOR]