A 67-year-old male patient presented with right scrotal swelling and underwent a right hydrocelectomy. A 1 cm paratesticular lesion was found within the hydrocele sac after entering the tunica vaginalis. Local excision grossly removed this in its entirety. Pathology returned as well differentiated papillary mesothelioma of the tunica vaginalis. Pathologic features and management options are discussed.