Pleomorphic adenoma is composed of epithelial and myoepithelial cells, and its tumor tissue contains epithelium, mucus, and cartilage-like components. It mostly occurs in the major salivary gland, but can also occur in the small salivary glands of the oral cavity, nasal cavity, pharynx, trachea, skin, breast and prostate [1,2,3]. Terada et al. reported the first case of pleomorphic adenomas in the spermatic cord, in a 59-year-old male patient. As the myoepithelial cells are free from the spermatic cord, and the spermatic cord is composed of urothelium, stromal cells, vasculatures, nerves, ganglion cells, and smooth muscle cells, the authors believe that spermatic cord PA is derived from the myoepithelial differentiation of urothelial cells [3].

Chondroid syringoma, also known as skin pleomorphic adenoma, originates from the sweat glands, and the reported incidence is about 0.01–0.098% [4]. Michael et al. reported three cases of skin pleomorphic adenoma, two in the inner corner of the eye and one in the eyebrow area [5]. The patient in our case had a long history, and the scrotal skin was ulcerated locally. During the operation, the pathological diagnosis of multiple pleomorphic adenomas was clear, and there was no obvious tumor invasion of the testis and spermatic cord, suggesting that it may have originated from the sweat glands of the scrotal skin. The imaging findings of this case were non-specific, and differential diagnosis with leiomyoma, rhabdomyosarcoma, or germ cell tumors should be considered clinically.

PA is a borderline tumor that usually presents as a painless, persistent mass. Patients with a long course or recurrent PA have a possibility of malignant transformation to malignant pleomorphic adenoma (MPA), and radical surgical resection is currently the preferred treatment for this disease. In this case, the patient had a long history, and the tumor capsule was invaded under the microscope, indicating the need for postoperative follow-up. Six months after scrotal mass resection, there was no recurrence in the patient at the time of writing this report.