Background: Testis is the site for a large number of neoplastic and non-neoplastic lesions of varied etiology which can occur in any age group. Testicular tumours are rare, affecting adolescents and young adults. Only limited literature is available on the epidemiology of testicular and paratesticular lesions from South India. Aim: A detailed 4 year histopathological analysis of testicular and paratesticular lesions including testicular tumours were undertaken. Materials and Methods: A total of 160 orchidectomy cases studied with retrieved blocks and slides from the department. A detailed clinicopathological correlation done. Serological markers and Immunohistochemistry done in required cases. Results: Our analysis showed 87.5% non neoplastic lesions with torsion testis being the most common followed by atrophic testis and tuberculous epididymo-orchitis. Of the neoplastic lesions (12.5%) malignant tumours were common compared to benign tumours and germ cell tumour constituted the predominant malignant lesion. Conclusion:The distribution of testicular lesions in patients attending our institution were comparable with available worldwide data.