Adenomatoid tumor is the most common paratesticular tumor. It usually involves the epididymis, although it may also occur within the testicular tunics or the spermatic cord. Papillary cystadenoma of the epididymis is a benign multicystic lesion. About one-third of cases occur in the setting of von Hippel-Lindau syndrome. Mesothelioma may arise from the tunica vaginalis and present as a painless scrotal mass along with a hydrocele. It may be associated with asbestos exposure.Genitourinary sarcomas in adults usually involve spermatic cord, epididymis and surrounding soft tissues. Primary mesenchymal tumors of the testis are uncommon. The most common genitourinary sarcoma in adults is liposarcoma, followed by rhabdomyosarcoma, leiomyosarcoma, and undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma). Embryonal rhabdomyosarcoma is the most common histologic subtype in men below 30 yrs. Most of these tumors are bulky and present as painless, palpable mass.Paratesticular sarcomas are managed with wide excision of the spermatic cord and testis with high ligation via an inguinal approach. Incompletely resected tumors are treated by repeat wide local excision and/or post-operative radiation. The long-term survival of men with paratesticular sarcomas is around 50%.