Tsili et al. Journal of Medical Case Reports 2011, 5:169 http://www.jmedicalcasereports.com/content/5/1/169 Sonographic examination showed a sharply-demar- cated hypoechoic, vascular left paratesticular mass, located close to the head of his epididymis. A large left hydrocele, with low level echoes was also found. MRI evaluation of the scrotum was done on a 1.5-T magnet unit, using a pelvic phased-array coil. The study included fast spin-echo axial, sagittal and coronal T2- weighted sequences and spin-echo axial T1-weighted sequences. Diffusion imaging was performed in the axial plane, using a single shot, multi-slice spin-echo planar diffusion pulse sequence. The maximum b-value was 900 s/mm2. A multilobular left paratesticular mass (Fig- ures 1, 2, 3), in close proximity to the testicular tunicae of the superoanterior aspect of his left testis was detected. The dimensions of the tumor were 33 × 34 × 32 mm. T1-weighted images demonstrated a mass isoin- tense to his testicular parenchyma (Figure 1). The mass was heterogeneous on T2-weighted and apparent diffu- sion coefficient (ADC) maps, with areas of high T2 sig- nal and ADC value of 1.56 × 10-3mm2/s, and others of very low T2 signal and ADC value of 0.86 × 10-3 mm2/s (Figures 2a, b, 3b). A large, left hydrocele, with a few septa and ADC value of 2.93 × 10-3mm2/s was also revealed. Both of his testicles, his epididymis and his spermatic cords were normal. The mean ADC value of his testicular parenchyma was 0.94 × 10-3 mm2/s and that of the epididymis 1.37 × 10-3mm2/s. His left testi- cular tunicae were intact. Based on MRI findings, the diagnosis of a benign fibromatous paratesticular tumor was suggested. Therefore, our patient underwent local excision of the mass. Histopathology reported an Figure 1 Transverse T1-weighted image depicts a multilobular left scrotal mass (arrow), located in the paratesticular space. The lesion had similar signal intensity, when compared to the normal testicular parenchyma (asterisk). Left hydrocele (long arrow). Page 2 of 4 Figure 2 T2-weighted images (a) Transverse and (b) sagittal T2-weighted images show tumor heterogeneity. The mass (arrow) was mainly hypointense on T2-weighted images, a finding suggestive of the presence of fibrous tissue. Left hydrocele (long arrow). Normal left testis (asterisk). adenomatoid tumor of the tunica albuginea, with abun- dant fibrosis. Our patient is now well, without signs of disease on clinical and sonographic examination, one year after surgery. Discussion Solid neoplasms of the paratesticular tissues are rare [1,2]. They affect patients of all ages, most commonly presenting as a slow-growing non-tender scrotal mass, as it was in our case. Adenomatoid tumors are the most common epididymal neoplasms, followed by leiomyo- mata [1-4]. These tumors are usually unilateral, more often seen on the left side, as in our patient. They are