The majority of extratesticular lesions are benign, with epididymal cysts and spermatoceles being the most common. Among solid lesions, malignancy incidence increases, but benign entities such as adenomatoid tumors, epidermoid cysts, fibrous pseudotumors and epidermal inclusion cysts still prevail. Suspicion for malignancy must be particularly higher at the spermatic cord level, especially when lesions do not clearly resemble hernias or lipomas.

An adequate diagnosis is essential to minimize unnecessary surgical interventions while also avoiding the misdiagnosis of malignant lesions.