We describe a case of a paratesticular paraganglioma in a 33-year-old man who presented with a scrotal mass and underwent a right testicular exploration. Metastasis is the only definite criterion for diagnosis of a malignant paraganglioma; however, lymphovascular invasion was noted in this case, which warranted a close clinical surveillance. The patient is currently well with no evidence of disease 18 months after radical orchiectomy. Paratesticular paragangliomas are extremely rare tumors with 6 cases reported in English literature. The histogenesis of these tumors is unknown. Though the histology and immunohistochemistry resemble those of paragangliomas at any other location, these tumors raise a plethora of differential diagnoses especially with the more commonly occurring tumors. Herein the relevant histopathologic differential diagnoses are discussed along with a brief review of literature.