Bilateral testicular atrophy and hypogonadism induced by paratesticular leiomyosarcoma and untreated cryptorchidism

Paratesticular leiomyosarcomas are rare low-grade malignancies from smooth muscle, presenting as painless scrotal masses in middle-aged men. This case describes a 48-year-old with a left-sided tumor and contralateral cryptorchidism, leading to bilateral testicular compromise and hypogonadism. He presented with asymptomatic left scrotal enlargement; examination revealed a 7-cm left mass and atrophic right inguinal testis. Labs showed normal tumor markers but primary hypogonadism. Imaging confirmed no metastasis. Bilateral orchiectomy yielded grade 1 pT1 leiomyosarcoma (positive for smooth muscle actin, desmin, vimentin) on the left and atrophy on the right. At 2-year follow-up, he remains disease-free on testosterone replacement.