Figure 1

Which testicular malignancy does this patient most likely have?

A 28-year-old male presents with a three-month history of a chronic cough and weight loss. Upon further discussion, he mentions a painless lump in his left testicle. A firm mass is felt in the left testis on examination. A chest X-ray reveals the pulmonary lesions seen here and a scrotal ultrasound confirms the presence of a heterogenous tumor. Blood tests demonstrate highly elevated beta-hCG, slightly elevated lactate dehydrogenase (LDH), and normal alpha-fetoprotein (AFP) levels. Which testicular malignancy does this patient most likely have? Image credit: @christopherblewett.

• Granulosa cell tumor
• Primary lymphoma
• Yolk sac tumor
• Choriocarcinoma

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