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Leiomyoma may originate at any anatomic location of smooth muscle in the genitourinary system. The kidney capsule is the most common site for the genitourinary leiomyomas. Leiomyoma origination from the scrotum is rare. The previous reported cases presented as small, firm, nontender, slowly enlarging freely movable masses within the scrotum. We report a case of leiomyoma of the tunica dartos, a benign lesion arising from the wall of the left scrotum. It presented as a pedunculated lesion with a surface ulceration, which need to be differentiated from squamous carcinoma of the scrotum. It was treated with a simple surgical excision.

Scrotal leiomyomas with atypical bizarre nuclei are rare, which might be misdiagnosed as malignant tumor. We describe a case of scrotal bizarre leiomyoma in a 65-yr-old man. The tumor was a 1 cm-sized, well circumscribed, oval mass arising from the tunica dartos muscle. Histologically, it was formed by whorling bundles of fusiform cells with occasional atypical, pleomorphic nuclei and pseudo-inclusions. Mitosis was not found. Although morphologically atypical, scrotal bizarre leiomyomas take on a biologic behavior not different from that of conventional leiomyoma, they should be distinguished from leiomyosarcoma to avoid unnecessary treatment.