Testicular smooth muscle tumors are round or oval shaped, substantial masses with a smooth surface. Testicular smooth muscle tumors are benign tumors that occur within the testes and are usually round or oval in shape with a relatively smooth, substantial surface. It is small in size and grows slowly. It mainly presents as a mass in the scrotal area. It is touched by chance during bathing as the first symptom, some patients have scrotal pain, and a few can have testicular pain due to testicular torsion. Testicular smooth muscle tumors have a low incidence and are often misdiagnosed. The most important test is ultrasound, which is characterized as fast, safe, and accurate, and is often used as the testicular pathology of choice to differentiate whether the mass is from within or outside the testis. Testicular smooth muscle tumor appears as a substantial hypoechoic mass on ultrasound. When accompanied by calcification, it appears as an uneven echo. All tumor markers for testicular smooth muscle tumors are negative and there are no sex hormone related clinical symptoms. In conclusion, if testicular smooth muscle tumor is present, it should be treated promptly.