Background: Malignant mesenchymal tumours originating from peripheral nerves or nerve sheath cells are classified as malignant peripheral nerve sheath tumours (MPNSTs), previously referred to as neurofibrosarcoma. Most cases of these lesions occur in patients diagnosed with neurofibromatosis type 1, while some instances may be linked to previous radiation exposure, and others arise sporadically. Case report: This report presents a 53-year-old male patient who experienced swelling in the scrotal area over the past 18 months. Clinical assessment and histopathological examination revealed a diagnosis of a perineal MPNST. Conclusion: Perineal MPNST is infrequent, presenting distinct diagnostic challenges and should therefore be considered in the differential diagnosis of perineal masses. The diagnosis was based solely on histological examination, lacking confirmation through immunohistochemical methods, which constitutes a limitation. Surgical resection yielded positive outcomes, as there were no signs of recurrence observed three months post-surgery with a longer follow-up period deemed necessary.