Giant testicular seminoma.

Primary testicular germ cell tumors typically present with painless testis enlargement and have a propensity to spread to the retroperitoneal lymphatics. Delays in seeking treatment are unfortunately common and may lead to metastatic spread. Pure seminomas are the most commonly seen on histology and are not associated with elevations in serum alpha-fetoprotein. Mild elevations in alpha-fetoprotein in the setting of a pure seminoma may be due to unrecognized nonseminomatous elements and rarely other benign etiologies. We present the case of a 42-year-old man with a large 31 cm stage I pure seminoma and mildly elevated alpha-fetoprotein level at presentation.