[Case of a testicular germ cell tumor presenting with multiple metastasized pulmonary nodules and masses]

A 25-year-old man presented with a 2-month history of bloody sputum and unilateral gynecomastia. High-resolution computed tomography (HRCT) of his chest showed multiple nodules and masses. On physical examination, no enlargement of the testes was noted, but a tiny calcified lesion in his left testis was detected on a genital CT scan. He was referred to the urology department with a suspected testicular germ cell tumor. An echogram showed a micronodule in his left testis. A testicular mixed germ cell tumor was diagnosed on the basis of the histological features of the tumor removed by high orchiectomy, and systemic chemotherapy with bleomycin, etoposide, and cisplatin (BEP) was initiated. Testicular germ cell tumor should be considered in the differential diagnosis of multiple pulmonary nodules or masses in young men. Because high orchiectomy is indispensable for the treatment of testicular germ cell tumor, aggressive investigative studies of the testis are essential in patients with pulmonary, mediastinal, and retroperitoneal germ cell tumors.