Background: Paratesticular fibrous pseudotumors are rare benignant intrascrotal lesions that can often mimic malignancy. They often arise in the scrotal tunic while less common localizations are the epididymis and the spermatic cord. Their diagnosis is challenging and often done post-operatively on definitive histopathology; for this reason, they are often treated with orchiectomy which results in overtreatment. Case Presentation: We present a case of a 42-year-old male patient that came to our observation for scrotal swelling. Physical exam and ultrasound showed a healthy testis but multiple painless, tender, oval lesions at the level of the epididymis. Laboratory tests and testicular markers were within normal limits, thus we planned explorative surgery with frozen sections that excluded malignancy. We performed testis-sparing surgery with epididymectomy, vasectomy, and resection of the tunica vaginalis. Definitive histopathology revealed a fibrous pseudotumor. To date, at 3 months follow-up, the patient is in good clinical condition with no signs of recurrence and with healthy homolateral testis. Conclusion: Fibrous pseudotumor can mimic malignancy. A correct diagnosis is pivotal to choosing the correct treatment and avoiding aggressive surgery.

Keywords: Benign testicular neoplasm, paratesticular fibrous pseudo-tumor, benign fibrous paratesticular tumor, testis-sparing treatment. inflammatory pseudotumor.