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JAMA Surgery Clinical Challenge
May 2018

A Large Abdominal Mass in a Young Man

Author Affiliations
  • 1Department of Urology, Singapore General Hospital, Singapore
JAMA Surg. 2018;153(5):489-490. doi:10.1001/jamasurg.2018.0050

A man in his 30s presented with abdominal pain associated with unintentional weight loss for 6 months. The patient had a history of hyperlipidemia. Results of examination revealed a palpable mass of about 15 cm in the left paraumbilical region. The patient had a normal right testis but a missing left testis. Results of a computed tomography scan of the thorax, abdomen, and pelvis revealed large intraperitoneal and retroperitoneal masses. The intraperitoneal heterogenous mass was 20 × 15 × 11 cm, with linear calcifications (Figure 1). There was a right moderate hydronephrosis. The retroperitoneal mass was homogeneous, with associated lymphadenopathy encircling the aorta, inferior mesenteric artery, and both renal arteries. A large left supraclavicular lymph node and left inguinal lymph node were also detected. There was no metastasis identified elsewhere. Serum lactate dehydrogenase was elevated at 1358 U/L (to convert to microkatals per liter, multiply by 0.0167), β human chorionic gonadotrophin was elevated at 1485 mIU/mL (to convert to international units per liter, multiply by 1.0), and α fetoprotein levels were normal.

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