Abstract
Testicular leiomyosarcoma is an exceptionally rare malignant mesenchymal tumour with limited documentation in the literature. We report the case of a 50-year-old male presenting with progressive scrotal swelling and pain, who was diagnosed with right testicular leiomyosarcoma with synchronous hepatic and pulmonary metastases. The patient underwent right high orchiectomy, followed by systemic chemotherapy. Disease progression occurred after anthracycline-ifosfamide, requiring second-line docetaxel. This case highlights the aggressive clinical course and therapeutic challenges of testicular leiomyosarcoma, underscoring the need for more cumulative evidence to guide management.