Clinical History: A 22 year old graduate student noticed a nodule partially distorting his left testicle prior to evaluation at the student health center. The examiner agreed that there was a nodule present distorting the normal testicular outline. During his pre-surgical workup a chest and abdominal X-ray demonstrated enlargement of his para-aortic abdominal lymph nodes. An orchiectomy was performed.

Questions:

1. In Figure D1 - Gross specimen from orchiectomy.  Discuss the diagnostic possibilities raised by the heterogeneous appearance of this tumor.

Several samples from the most irregular parts of the specimen are submitted for histology:

2. In Figure D2, what are the characteristic features of this tissue?

3. In Figure D3 , what are the characteristic features of this tissue?

4. In Figure D4.  How do you account for the presence of two neoplasms in the same tumor?

5. Do the features seen in Figure D4 alter the prognosis?