A Rare Case of 32 Years Old Male with "Burned Out" Testicular Germ Cell Tumor

32 years old male presented with right lower limb pain and swelling. Lower limb duplex showed thrombus in common iliac veins and thrombus in IVC. CT scan showed thrombi in common iliac veins extending to IVC and filing defects in pulmonary arteries representing pulmonary emboli. There was also a retroperitoneal necrotic mass with foci of calcification on the right side adjacent to IVC bifurcation. The chest CT showed multiple pulmonary nodules suspected to be metastasis. US of testis showed Coarse calcification in the upper pole of right testis. PET-CT showed intensely increased FDG uptake in the pulmonary nodules as well in the retroperitoneal mass, with symmetric accumulation in both testis suggesting physiological uptake . The patient underwent thoracoscopic segmental resection of LUL for tissue diagnosis. The pathological diagnosis was germ cell tumor consistent with embryonal carcinoma. The patient was referred to oncologist for chemotherapy and to urologist to plan orchiectomy.