A 51-year-old man presented with a 2-year history of painless lump in the left hemiscrotum. Scrotal examination demonstrated a 3-cm, firm-to-hard mass attached to the left spermatic cord. Scrotal ultrasound scan revealed a hetero-geneous mass separate from the left testis and epididymis. An orchidectomy was recommended to the patient; however, he declined surgery and underwent excision biopsy of the lesion with preservation of the left testis. Histology suggested a leiomyosarcoma of the spermatic cord and positive margins. Following a normal staging CT scan, the patient was referred to the regional sarcoma clinic. He was treated with an orchidectomy. Microscopic examinations showed fibrosis in the spermatic cord and negative margins. The patient has been followed up for 12 months with CT scans and shows no signs of recurrence. © 2007 Canadian Urological Association.