Acute scrotum is a condition which often causes diagnostic difficulties despite all the available investigation methods. Ruling out or confirming torsion of the testis is the main problem in most cases. Other more rare conditions, however, need acute exploration such as illustrated in this case report, where the sudden bleeding in a testicular neoplasm caused severe acute symptoms. The tumor may not necessarily be clearly apparent during surgery. Peroperative analysis of a specimen of testis tissue is therefore recommended in such cases.