title: A case of malignant abdominal pain.
abstract: BACKGROUND
  Testicular cancer is a common neoplasm in young and middle-aged men. Although the most common presentation is a palpable testicular mass, it can present with atypical symptoms. There is a lack of awareness among primary-care physicians about the less common presentations of testicular tumors. Early detection is a key prognostic variable. This case demonstrates an unusual first presentation of testicular cancer with chylous ascites and abdominal pain.
  
  
  METHODS
  We report a case of a 19-year-old man who presented with severe atypical abdominal pain, which was initially diagnosed as acute appendicitis. He underwent laparoscopic appendectomy and was found to have chylous ascites and a normal-appearing appendix. As part of his work-up for chylous ascites, he was found to have mesenteric lymphadenopathy. These nodes were sampled and revealed a mixed germ cell tumor. The primary tumor was later traced to his right testis.
  
  
  CONCLUSIONS
  The differential diagnosis of atypical abdominal pain in young men should include testicular tumors. A thorough testicular exam should be part of the routine physical exam in such situations.
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Raghuwansh P
authors.initials: RP
authors.lastname: Sah
authors.forename: Rajeswari
authors.initials: R
authors.lastname: Anaparthy
authors.forename: Aravind
authors.initials: A
authors.lastname: Sugumar
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications* / Q000175:diagnosis*; D013736:Testicular Neoplasms / Q000150:complications* / Q000175:diagnosis*; D055815:Young Adult