A 40-year-old man presented with abdominal pain and right scrotal swelling. Physical examination revealed a right testicular tumor and CT scan showed a large retroperitoneal mass. The patient underwent right radical orchiectomy, and pathology showed mixed germ cell tumor. After 1 cycle of chemotherapy, CT scan showed interval enlargement of the retroperitoneal mass. Percutaneous biopsy was consistent with teratoma. The patient refused surgical intervention and was noncompliant with follow-up. Four months after presentation, CT scan showed increasing abdominal lymphadenopathy. The patient received 4 cycles of chemotherapy. He presented 4 months later with massive lymphadenopathy and expired before planned palliative surgery.
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