Introduction 16 32 1 2 Table 1 Macroscopic mimickers (pseudotumors) of testicular and paratesticular neoplasia Vascular lesions   Intratesticular hemorrhage   Segmental testicular infarction   Organizad testicular hematocele     Cholesterol granuloma of the tunica vaginalis Inflammatory lesions   Nonspecific infectious inflammatory lesions   Specific infectious inflammatory lesions   Non-infectious inflammatory lesions     Idiopathic inflammatory lesions      Idiopathic granulomatous orchitis      Testicular malakoplakia      Testicular sarcoidosis   Meconium periorchitis   Sperm granuloma Cysts   Testicular cysts     Albuginea cysts     Parenchymal cysts (Epidermoid cysts)     Rete-testis cysts- Cystic displasia of the rete testis   Epididymal cysts and Spermatoceles   Spermatic cord cysts Ectopic tissues   Adrenal cortical rests   Spleno-gonadal fusion Testicular appendages Miscellaneous other lesions Fibrous pseudotumors; (Fibromatous periorchitis-Nodular periorchitis)   Amyloidosis   Polyorchididm   Sclerosing lipogranuloma Table 2 Microscopic mimickers of testicular and paratesticular neoplasia Testicular   Inflammatory-reactive lesions    Lymphocitic orchitis (Testicular pseudolymphoma)    Rosai-Dorfman disease   Sertoli cell hyperplasia     Pick adenoma     Hamartomatous proliferation testicular feminization syndrome   Interstitial cell hyperplasia     Leydig cell hyperplasia     Testicular “tumor” of the adrenogenital syndrome   Hyperplasia of the rete testis Epididymis   Adenomatoid hyperplasia Tunicas albuginea-vaginalis   Mesothelial hyperplasia Spermatic cord   Vasitis nodosa   Inflammatory pseudotumor (Funiculitis proliferans) Miscellaneous other lesions Macroscopic mimickers (pseudotumors) of testicular and paratesticular neoplasia This group of lesions refers to those that macroscopically imitate a neoplasia. Frequently, these lesions affect both compartments and are therefore difficult to establish if one or both are affected. For this reason, we classify the tumor-like lesions according to their etiology. Vascular lesions 24 15 20 43 103 21 94 45 45 53 1 81 89 2 61 86 Fig. 1 a arrows b  Fig. 2 Cholesterol granuloma in the tunica vaginalis (H&E)  Inflammatory lesions 38 23 84 44 87 49 5 42 9 Noninfectious inflammatory lesions. This group of tumor-like lesions include different entities among which can be highlighted: 4 3 70 72 1 4 19 56 31 56 57 85 109 110 64 100 39 83 29 107 5 6 108 22 Fig. 3 Idiopathic granulomatous orchitis characterized by tubular granulomas (tubular orchitis)  Fig. 4 a b  Fig. 5 a b  Cysts 33 74 107 6 54 106 14 7 69 68 108 46 105 65 55 Fig. 6 Epidermoid cyst, which must only be lined with squamous cell epithelium (H&E)  Fig. 7 a arrows b  Ectopic tissues 17 102 8 90 41 9 30 30 60 95 41 26 Fig. 8 Ectopic adrenocortical tissue. Adrenal cortical nodes surrounded by a connective tissue band in continuity with epididymis. (H&E)  Fig. 9 Splenic–gonadal fusion. The ectopic splenic tissue in close relation with the upper pole of the testis (H&E)  Testicular appendages 10 93 101 Fig. 10 Normal testicular appendages  Miscellaneous other lesions 11 96 71 108 108 10 34 13 79 Fig. 11 a b  Microscopic mimickers of testicular and paratesticular neoplasia Lesions or cellular changes that microscopically imitate a neoplasia are included under this category, whether or not they make a clinical mass. These changes are closely related to the structure of the organ in which they arises, as follows. Testicular Inflammatory-reactive lesions 2 3 12 ; 25 Fig. 12 a b  Sertoli cell hyperplasia 13 77 13 40 Fig. 13 a b  82 76 Interstitial cell hyperplasia 14 62 Fig. 14 Leydig cell hyperplasia  18 48 91 78 18 Hyperplasia of the rete testis 35 63 99 62 Epididymis 93 Tunica albuginea and vaginalis 73 80 15 11 98 97 11 28 27 28 Fig. 15 Mesothelial hyperplasia. The bland nucleus, no true invasion and associated inflammatory elements, can be useful to distinguish from malignant mesothelioma  Spermatic cord 36 75 16 7 8 104 36 88 37 50 58 92 12 51 47 Fig. 16 Vasitis nodosa. Ductular proliferation with a microglandular morphology  Embryonic remnants 67 59 66 52 27 The lesions described constitute a large heterogeneous group, without etiological or pathogenic relations among them or with true neoplasias. However, in spite of that, the patient with one or more of these tumor-like and/or benign mimickers can have a concomitant or ulterior true neoplasm.