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<p>Abstract</p> <p>Introduction</p> <p>Cellular angiofibroma is a benign vascular neoplasm that typically arises in the paratesticular region in men and is easily confused with inguinal or scrotal hernia.</p> <p>Case presentation</p> <p>We present a case of a cellular angiofibroma arising from the spermatic cord of a 74-year-old Caucasian man. Initially, the lesion was confused with a scrotal hernia, but imaging revealed a subcutaneous, inhomogeneous, but well-circumscribed lesion to the surrounding tissues with rich vasculature. Surgical resection of the lesion was performed. Histology revealed a benign tumor of vascular origin rich in fibroblasts.</p> <p>Conclusions</p> <p>Angiofibroma can easily be confused with an inguinal hernia and should be differentiated from Schwann cell tumors, perineuromas, spindle-cell lipomas, aggressive angiomyxomas, angiomyofibroblastomas, solitary fibrous tumors, spindle-cell liposarcomas, and leiomyomas. A safe initial diagnosis is difficult because of its location, nature, and correlation with other structures of the area.</p>