Sequential Germ Cell Tumor without Prior Involvement of the Testes

We report on a patient who presented with a metastatic germ cell tumor and had a normal testicular examination. A complete response ensued following combination chemotherapy. A sequential germ cell tumor of the testes developed 20 months after the chemotherapy was stopped. This occurrence of clinically evident disease in the testes is consistent with either a second primary tumor or with recurrent disease from an occult focus not eradicated by prior systemic chemotherapy. Our case is compared to other cases of sequential germ cell tumors reported in the literature.