Playing the long surveillance ball game: Metachronous testicular tumor developing after treatment and remission of extragonadal germ cell tumor

A 32-year-old man with vague abdominal pain was found to have enlarged para-aortic and mediastinal lymph nodes on computed tomography. He was diagnosed with retroperitoneal mixed germ cell tumor as confirmed on percutaneous biopsy. At the time of diagnosis, lactic dehydrogenase, human beta-chorionic gonadotropin, and alpha-fetoprotein were elevated. He completed four cycles of platinum-based chemotherapy with excellent response and no clinical disease progression. Three years later, he presented to the Urology clinic with a right testicular mass. His tumor markers remained negative. He was taken for a right radical orchiectomy with the pathology resulting in pure seminoma (pT1Nx).