title: Testicular pain as a presentation of Cowden syndrome.
abstract: This case report outlines a rare case in Cowden syndrome and PTEN (phosphatase and tensin homolog) gene mutation and how it may initially present to the urologist. Also known as multiple hamartoma syndrome, Cowden syndrome is a rare disorder associated with the development of several  types of malignancy. A thorough search of the literature reveals limited information regarding its presentation to the urologist. We report the case of a 47-year-old gentleman with a two-week history of worsening pain and swelling in his left testicle. Testicular ultrasound revealed multiple  hyperechoic areas bilaterally suggestive of multiple lipomas. He was also found to have macrocephaly, freckling of his glans and foreskin and an enlarged nodular goitre and the geneticist diagnosed Cowden syndrome. The disease is discussed and guidance is given on its management and follow  up.
authors.affiliation: Department of Urology, Epsom and St Helier University Hospitals NHS Trust, Epsom, UK. huss@doctors.org.uk
authors.forename: Hussain M
authors.initials: HM
authors.lastname: Alnajjar
authors.forename: Arun
authors.initials: A
authors.lastname: Sahai
authors.forename: Andrew
authors.initials: A
authors.lastname: Keane
authors.forename: Stephen
authors.initials: S
authors.lastname: Gordon
mesh_terms: D004487:Edema / Q000209:etiology; D006223:Hamartoma Syndrome, Multiple / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D013733:Testicular Diseases / Q000209:etiology*